• By Dartington SRU
  • Posted on Monday 24th January, 2011

Early years come into their own

Early years intervention in the UK has received a big boost in the last couple of months. First, just before Christmas, Frank Field, a Labour MP, came out with a review of poverty arguing that good parenting, not income determined children’s outcome.This was followed this week by a fellow Labour MP Graham Allen also publishing a review for the Coalition government making the case for a massive shift in government spending to the early year (see:Launch of the Allen Review on Early Intervention Launch of the Allen Review on Early Intervention ). Another review, also commissioned by the government on early years education is due soon from Dame Clare Tickell, head of the big children’s charity, Action for Children. And now the Greater London Authority (GLA) has produced a report exploring the economic case for investment.The GLA report pulls together compelling evidence from around the world to demonstrate how inequalities in health in London could be addressed, in part, by investment in “well-designed and implemented early years programs”.Like the Allen review, the potential of home visiting programs, in particular Family Nurse Partnership (FNP), and pre-school programs to improve child outcomes is highlighted in the report.To conduct the GLA review, the UK team drew heavily on evidence from the US, not because child outcomes are any better in the US but because evaluation on the impact of programs tends to be conducted to a higher standard. US researchers routinely test interventions using experimental methods, like randomized controlled trials, as these tend to give a more reliable estimate of impact than other types of evaluation methods.The GLA economic case rests on the identification of programs that not only work, but that also offer better benefits for their costs. For example, FNP is an intensive, structured home visiting program that supports young, first-time mothers through pregnancy and the first two years. The cost per children is estimated to be $9,118. The Net Present Value (the difference between the discounted lifetime costs and benefits) is $17,152.These figures tell us two things: it is an expensive programme but it makes such an impact that it produces considerable savings over the child’s life.An economic model developed over 15 years by the Washington State Institute for Public Policy provides the technology for these types of calculations (see: Social Research Unit Annual Lecture: Steve Aos talks about picking them, passing them, and doing them). With modest adjustments for the UK, the GLA reviewers were able to make even-handed comparisons of programs for their impact, cost and benefit. Even though the US and UK contexts have some noticeable differences, such as the much higher rates of incarceration in penal facilities in the US, the programs to reach their Top 10 list were broadly the same in both countries.The Top 10 list included early childhood education like the Perry Pre-School program (a high quality pre-school program for three and four years-old born into poverty at high risk of failing in school); Parents as Teachers (a monthly, long-term home visiting program that helps prepare children for school); the Good Behavior Game (a classroom management strategy to address aggressive and disruptive classroom behavior); and Parent-Child Interaction Therapy (an intensive, clinic based approach where therapists coach parents to develop positive behaviors).While the report makes a very strong case for intervening in the early years (0-5 years), like the Allen review, it also acknowledges that early intervention can be effective for children across the age range if the activity happens early in the development of problems.As well as identifying good candidates for investment, the analysis draws attention to programs that would constitute riskier investments, either because they tend not to make detectable improvements to children’s lives, or because the investment is not offset by the gain.The Even Start program is a case in point. The program aims to improve literacy through child and parent education but evaluations have found no detectable benefit. This means that the cost outweighs the benefit.From an investment perspective, in a city like London, there are certainly opportunities to make better use of public money. There is incontrovertible evidence from longitudinal studies of the knock-on effects on child development of growing up in disadvantaged environments. With two in five children living in poverty, activity to improve learning abilities, behavior and parental relationships could help narrow the gap between rich and poor and begin to reduce inequalities in health.Although it is hard to be precise, respected experts, like Professor Sir Michael Marmot, president of the Royal College of Paediatrics and Child Health, estimate that inequality in illness costs the UK in excess of £65 billion annually in lost productivity, higher health and welfare costs and lost taxes. A small reduction in inequality could save millions of pounds, which seems compelling from both a social and a financial perspective.Viewing intervention as an investment comes with some cautions. The current structure of financing the work means that the funder is often not the agency that sees the return. In the case of FNP, the National Health Service has so far been the main funder in the UK. The benefits of more success in education, reduced child abuse and neglect, and reduced crime are felt by the justice, education and social care system, and not health. The system of incentives will need to alter for these agencies to be motivated to direct funds to this type of activity.A redirection of money away from ineffective activity - for example, those early years interventions that lack intensity and are not targeted - could be viewed as a less risky or easier approach to investment.This is no panacea as the GLA report makes clear that programs are only a part of a possible solution to narrowing the gap between income and health inequalities. For them to do that they need to be located in a system that routinely screens families to identify difficulties early on and has well-trained, motivated staff who are able to engage competently with families. And perhaps more importantly, such activities need to be closely linked to action to secure family economic wellbeing more generally.References: 
GLA Economics (2011) Early Years Interventions to Address Health Inequalities in London: the economic case, London, GLALinks:

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