Seven years making the case for early intervention: Carey Oppenheim and Jo Casebourne, in conversation
July sees EIF turning seven years old. To mark the occasion, and reflect on the changes within and around EIF over that time, former and current chief executives Carey Oppenheim and Jo Casebourne sat down for a long-distance coffee and a chat.
Jo: What’s your strongest memory of those first few months in charge, back in 2013? Was there something in particular that you were very focused on, in terms of building up EIF’s reputation and it’s standing with stakeholders and the wider children and young people community?
Carey: When I started at EIF, it was just a single row of desks on the fourth floor of the Local Government Association offices – which I remember as having a very temperamental internet connection – so it’s come a hugely long way. At the beginning it was about building an organisation, internally and externally. In those early days, there was this big vision for early intervention that had been set out by Graham Allen in his report for the then-Coalition government. I was preoccupied with how you translate that vision, how you transform it into a living, breathing organisation, one that can work with all the other organisations and people who had an interest in early intervention at the time. I was very lucky to have two very talented colleagues: Leon Feinstein as Director of Evidence and Donna Molloy as Director of Implementation. They were key partners in developing the organisation and establishing its reputation. EIF sits at an intersection between evidence, practice and policy – and together we attempted to craft an organisation that reflected that approach.
A strength, and challenge, of early intervention is its cross-cutting nature. We had four government department sponsors and over the years it often it felt as though we were helping them join up the dots rather than the other way round! We had a set of key performance indicators from the Department for Education, and so part of the initial task was about how to make those real and meaningful in our work, as well establishing our credibility with government. Our trustees were immensely helpful and closely involved in those early days – and beyond – in terms of putting EIF on a positive track and opening lots of important doors.
Looking outward, we put in a lot of time and effort into a series of masterclasses or ‘roadshows’ across the country, bringing together the evidence that we had at that stage about early intervention. Then, it was still pretty early on in terms of having our own body of evidence to present, so a lot of it was actually about establishing relationships with local areas. We were very focused on choosing the 20 pioneering places that we were going to work in our first few years. These were local authority areas and partnerships, and they needed to have that real commitment to early intervention and a plan for what they might do. Looking back, I think 20 places was a huge number – perhaps we would have been better served to focus on, say, five or six places to work with in a more in-depth way.
But at that point, really, it was about reaching out and building relationships wherever we could. When I started, there were lots of existing relationships that had been built up by Graham and the founding trustees, so we weren’t starting from scratch. We had relationships with local areas, the children’s charities, think tanks, social investors – but it was really about trying to understand how you work with those organisations and places in a systematic way.
Making the case
Carey: EIF is at a very different stage now, but when you joined EIF as its second chief executive, you came from outside of the sector. From that vantage point, how strong do you think the awareness was of what early intervention and early help were all about?
Jo: I think that, at first, there had been this fantastic focus on early intervention, brought about through Graham’s work, the early work of EIF, the support for EIF from the government and so on – there was a real moment when early intervention was at the forefront of people’s minds. But then there was a great deal of turbulence through EIF’s early years, as you well know, in the political context that swirled around the foundation and its work. As a result, I think the focus and attention of national politicians and policymakers had drifted a bit from early intervention and the fantastic work that EIF was doing. It needed a boost, like Graham’s report had given it in the first place. People still felt that prevention mattered, but I don’t think the argument with the Treasury had been fully won in terms of what were the hard economic benefits from earlier action and prevention in public services more generally. It felt to me that there was a need to reinvigorate that debate, to get together with other organisations who were very focused on prevention in public services, and to refresh the arguments for early intervention itself.
I was able to come in, building off the fantastic four years’ work you’d done leading EIF, and work with colleagues to take that to a new generation of policymakers and politicians. So many people had moved on, both in the civil service and at a political level, with changes of governments and so on, that remaking the case for early intervention felt really important to me. So that was one of the things I focused on first: to set down “what have we learned?”, and to take that back and say to everyone “this is why this matters now” – much as you and Graham and other politicians had done four years previously.
Carey: Yes, I think that’s absolutely right. When EIF started out, there had been these four big reports that the Coalition government had commissioned on children, one of which was Graham’s report on early intervention. There was a sense of momentum: an early intervention grant had gone into local authorities, which meant real money to work with.
But really, even by 2013, things were starting to change. Pressures on local authority spending and therefore on early intervention budgets were starting to bite. So I think actually when we began, although there was knowledge and understanding about early intervention and what it meant in the local context and more widely, the financial and economic environment was already becoming quite challenging. So that’s right: by the time you came in, it needed a reboot and to be re-presented to a fresh audience.
Putting evidence at the heart of EIF’s work and others’
Jo: Obviously evidence is at the heart of the What Works movement, and EIF was one of the first What Works centres to be set up by the government, following in the footsteps of NICE. How did you set about putting evidence at the heart of EIF’s work, and were there particular challenges in those early years?
Carey: Indeed, the What Works Network was still establishing itself then, and there were a number of challenges for us to contend with. The first was quite practical: we had to establish our evidence standards, which we knew would underpin all our work – and still live on today. That was a big part of the work we did at the very beginning: developing a set of evidence standards that were high quality and recognised as being valid, turning those standards into what became the EIF Guidebook, and then – what turned out to be much more challenging – communicating those standards and ensuring people understood what we were doing, and why.
Creating the Guidebook was a complex exercise, and applying those evidence standards to real programmes and working with the organisations that sit behind those programmes took a lot of time, diplomacy and back-and-forth. In retrospect, we probably needed to think more about how we were going to communicate with everyone involved about the evidence standards. It was an incredibly important part of being recognised as serious and authoritative, and I think we got there in the end.
The second thing we had to do was more organisational: we had to build an evidence team. Initially the evidence side of the organisation was smaller than the ‘advice’ side, but it became clear we’d have to strengthen it. Honestly, we hadn’t anticipated how much work was going to be involved in assessing early intervention programmes and turning that information into a real, living online resource. But that rigour was a crucial part of our credibility with politicians and policymakers. Graham Allen had spent a lot of time building a political consensus across party boundaries, and the What Works ethos was all about the evidence, so when EIF was formed, it was essential that we were seen to be objective, robust and independent. It took time, but it felt like we were laying down an important foundation.
Carey: Now, seven years on, the What Works network continues to grow. How do you think the demand in policy and services circles for evidence and evidence-based guidance has changed over recent years?
Jo: This is something we reflected on when I started, three years ago, when (rightly) we were putting a lot of emphasis on evidence-based programmes and building up the Guidebook to where it now has over 100 programmes – which is amazing if you think about where you started and how much work that took. But we realised more and more that people were asking us different kinds of questions: not just ‘which evidence-based programme should I commission?’ but also ‘how do I transform a whole system to put early intervention at the centre?’ or ‘what does the evidence say about frontline practice or workforce development?’.
So, the first challenge is to make sure we’re providing the right kinds of evidence. Through our new strategy, we have intentionally taken a broad view of evidence, beyond programmes in the traditional sense. We’re putting more of an emphasis on helping others to actually generate evidence, to help build the evidence base in the first place, and on providing support and guidance for the evaluation activity that is essential if we’re going to increase the supply of high-quality evidence. We totally recognise the challenges that local authorities face, so we’ve thought a lot about the types of evidence we should be interested in and broadened our work to provide information and guidance in new areas.
The flipside is to look at how we build the demand for evidence, and how we make sure this evidence is getting used. We all know it’s not enough just to put stuff on a website and expect people to come. So it’s interesting to hear you talk about the need to build up the evidence team at EIF, because I think by the time I arrived it felt like we had come full circle: we actually needed to strengthen the policy and practice side of the organisation. We had a fantastic base of evidence to share but we needed more ‘firepower’ to get it out there, to turn it into tools and resources that people would find practical and useful. So we’ve invested in that side of the organisation – and we’ve been trialling different ways of getting the evidence out there, into the hands of those people who make so many important decisions about commissioning and funding and so on.
Supporting transformation at a local level
Jo: Looking back, what changes did you see in terms of how local authorities and services were able to respond to the evidence and guidance that EIF was putting out in its early years?
Carey: Back then, I think it was partly about building that recognition of the importance of evidence and of using that evidence to scrutinise what areas were already delivering. We were producing evidence reviews on different issues, which meant they could look at the programmes or services they had commissioned and start to make some assessments about what they should carry on doing and potentially what they might stop doing. It was about awareness-building and thinking about how you might use the evidence to inform your commissioning decisions.
In certain areas, like EIF’s work with the police, what we saw was an appetite from those working on the ground, who were dealing with young people with complex issues, and who knew that the real source of what was going on lay in someone’s home or in their community. We teamed up with a number of police forces – the Academy for Police Leaders – to support them to work in a more evidence-based way, and to be very practical about how they could change some of their ways of identifying and responding to issues. We did see changes, and now early intervention is much more built-in and commonplace part of how some police forces approach their work.
What I think was trickier was that many of the people in local government who were focused on early intervention or early help or early years were working in an increasingly challenging context, which meant that achieving the sustained focus required to work together in a systematic way was difficult. I think you’ve got to really grasp the complexity that comes with working with multiple services and agencies across a local area: that systemic approach feels very important if we’re going to embed early intervention in a more secure way.
Building our understanding, preparing for recovery
Jo: Since leaving EIF, you’ve written a fabulous book on family policy and started working with the Nuffield Foundation on early years. What has struck you most about the current policy landscape for children and families and how it has changed over the last few years?
Carey: I think there has been real progress in some areas. The maturation of the What Works centres and the emphasis in government policy circles on the importance of robust research and evidence is reflected in the quality and sheer amount of work that has been done on families and children, by EIF and other organisations. The work on family conflict that EIF was very involved in early on, and continues to be very involved in, has really thrown new light on thinking about children in the context of family relationships – and the DWP is now leading that agenda in government. The emphasis on social and emotional wellbeing and mental health – which actually was there right at the beginning and was a key insight in Graham Allen’s work – has enabled the research to continue to build up and the policy to follow alongside that.
But we know there are still gaps in the research, and other kinds of gaps as well. Working at the Nuffield Foundation now on early childhood, I have become acutely aware of the very fragmented picture we have of children’s lives, which is reflected in the data we have available, the research that we can do, and our policy and practice responses. We still find it very difficult to connect the different data sets that exist, and as a result we can’t fully understand children’s journey through the various systems, whether they’re at high risk, and what their outcomes are in the end. We know little about children growing up in more complex or blended families. This is problematic, both in terms of ensuring we’re able to meet children’s needs at the time that they need to be met, and more generally, in terms of how we use resources and ensure policy is keeping up.
Then, I think there’s a big gap around implementation. There is much less funding around for projects which try to understand what happens when research is put into practice, and how it might need to adapt. That feels like a very important area to focus on – especially right now, as we face this huge challenge of recovering from Covid-19.
The other thing to mention from the book – and particularly given the huge economic hit following in the wake of Covid-19 – is the importance of the socioeconomic context: what’s going on around families, as well as what’s going on inside the home. Things like parenting or conflict between parents don’t happen in isolation. So we have more to do in terms of thinking about cross-cutting research and cross-cutting responses during this next period, amid what will be rising child poverty rates and a much more difficult context in which to both provide services and respond to children’s needs effectively.
Jo: Yes, definitely. Every time there’s a major economic shock – and clearly this is going to be one of the biggest we’ve seen for a long time – in the aftermath we see that it’s young people that suffer the most. We can see the potential for disrupted education, and the reduced opportunities for young people entering the labour market. So, rightly, a lot of focus at the moment is on these older young people who are transitioning into adulthood – but I agree, it is worrying that there is this lack of focus on younger children.
We need to be providing support to all age groups. We need to provide that early support to help children and families tackle the myriad issues that have arisen in the last few months, and to ensure that our under-5s are ready for school, because we know that once those gaps open up in early childhood they just become entrenched and continue to widen through the school years. We know there will be children dealing with new or intensified mental health concerns; sadly, we know that there’s been a rise in domestic abuse and other issues associated with the many pressures that families have been under. So yes, I welcome that focus on older children who are transitioning to further education or the workplace – but we really need to get the focus on these younger age groups as well. Because without that investment – and this comes back to what early intervention is all about – without that investment early, we’re going to pay the price later, in terms of having an even bigger generation of children and young people dealing with more issues over a much longer period of time.
Carey: I completely agree. EIF has just brought out these two reports on Covid-19 and its impact. What would you see as the most important things to come out of that work?
Jo: For me, our work has underscored the need for services to be properly funded in the recovery from Covid-19, and more generally for us to be thinking about services for children and families as part of the social infrastructure of the country. There’s been a lot of focus on investments in physical infrastructure – ‘shovel-ready’ projects to get people back to work – but social infrastructure is just as important for the future of the country. We’ve seen people coming together to support health workers and care workers, and we need to come together for children in the same way.
We also need to build on some of the great examples of innovation we’ve seen in local areas, as they’ve adapted quickly to keep some level of services running. It’s been brilliant to see how some of the longstanding barriers to getting services working together have been brought down. Now, we need to make sure we retain what has worked well through this period, and don’t just go back to the old ways of doing things. That does mean we need to critically evaluate some of the ways that services are being delivered right now. The switch towards delivering services remotely – via online and digital means, for example – has been great in some ways, because it means many children have continued to receive a level of support, but we do need to know if these approaches work as effectively, and identify which of these new methods we want to keep in place. For me, that evaluation and learning process is a key part of what comes next.
Jo: This is an exciting and challenging time for all of us. Looking back, then, how do you think early intervention and its place in the world has changed over the last seven years?
Carey: On the whole, I feel very positive. I think that early intervention has got greater currency and is understood better than it was seven years ago. And there are some real practical examples of that, in terms of the ways local agencies are working together and innovations happening in local communities. We can see that early intervention and prevention are prominent in the Department of Health and Social Care’s long-term plan; we see it featured in strategies on social and emotional learning and mental health in schools; we see it in the DfE’s emphasis on early years education and the importance of supporting early communication and language skills.
So I think what has happened is that early intervention has been this big, broad concept that lots of people have been able to relate to, and now we are starting to see tangible examples of what it means in practice. It feels like a strong foundation on which to build. Today, the challenges are about how we maintain that focus on early intervention at a time when the government and economy are in crisis mode. How do we keep our eyes on the long term, to ensure we come out of the crisis with a more robust set of policies and more effective ways of working with children and young families, so that we’re better protected in future. I think early intervention is very well placed to have a real influence on how we emerge from the current situation stronger and in a better position to help those who need it most.