• By Dartington SRU
  • Posted on Thursday 03rd May, 2007

Why do we sometimes care so little about what children need?

Comparisons between medical and social care services can be misleading — there is a limit to the parallels that can be drawn — but we would hardly expect a doctor to continue prescribing a certain procedure or treatment if there was no evidence for saying that it worked. So, at this most rudimentary level, why are we so accommodating when it comes to the developmental care of our children?Columbia University's Jane Waldfogel discusses the questionable ethics of aspects of our response to children’s needs in her new book What Children Need (Cambridge, MA, USA: Harvard University Press, 2006 ISBN 0-674-02212-2), where she sets out a manifesto for the development of services in the United States. Information about the value of interventions is increasingly accessible, she argues, whether through systematic reviews (see Barlow et al 2006) or databases (e.g. Promising Practices). Indeed, we should be encouraging parents to make use of them — much as they might to question the efficacy of certain medication. If, as consumers of childcare, out-of-school programs and other children’s services, parents insisted that their money is spent wisely - it would raise expectations of evidence, and that in turn would promote the value of randomized controlled trials. Surely better all round.It is sobering to reflect that Waldfogel can set out this argument before an American readership, when, had she been limited to the UK evidence, she could not have assembled it. The idea of random allocation remains anathema to many in the field, despite well-rehearsed arguments in its favor, and much provision would struggle to achieve the precision that characterizes proven models in terms of their desired outcomes, target group, service components and underpinning logic.Those troublesome fundamentals apart, then, what would a children’s services system based on evidence and respect for choice look like? Waldfogel starts from the core principles of respecting parental choice, promoting service quality and supporting employment. These are followed by two more principles for allocating public resources: efficiency — achieving the largest possible gain for the investment made, and equity — promoting equality of opportunities and outcomes.The four central chapters take key developmental stages in turn – infants and toddlers, pre-school, school-age and adolescence – and consider what children of those ages need, how parents influence such children’s well-being and what the evidence base indicates works in terms of improving the children’s health, social, cognitive and emotional development. She gives most weight to the evidence from controlled experiments. Policy implications are drawn in each chapter and brought together in a seven-point plan at the close.The book is consistently clear and straightforward without avoiding difficult issues. For example, it highlights tensions between some of the principles it lays down: steps to enhance services may drive out of business providers that parents would have chosen (quality vs. choice), and a service that improves, say, school readiness may actually be rather expensive (equity vs. efficiency). Although primarily concerned with service provision in the US, and drawing mainly from a US evidence-base, the book has much to say to readers in other wealthy countries. First, it makes interesting cross-country comparisons. Waldfogel wrote the book during a sabbatical year at the London School of Economics and she notes with approval the UK’s National Childcare Strategy which has helped improve pre-school provision via staff qualification levels, child-staff ratios, a more structured curriculum, and so on. She also suggests bringing the long US schools summer holiday into line with several European countries, where the school year is up to 20 days longer, because the lowest-income families lose most ground over that period. Following recent evidence showing that the UK has the worst child well-being out of 21 European states (Adamson 2007) it is helpful to be reminded of the things that we do well, although seemingly ‘good’ policies do not always translate into good outcomes.Second, the book is relevant to the re-focusing of children’s services in the UK and elsewhere. Waldfogel acknowledges that her proposals are costly but argues that they will save money in the long-term by improving children’s health, school readiness and academic achievement and by reducing risky behaviour in their school and adolescent years. She does not advocate necessarily spending more but instead calls for wiser investment of current funding, in large part through implementing proven programs. Such models are becoming better known in the UK, for example through Incredible Years in Wales (Hutchings et al 2007) and Triple-P (as part of the Government’s ‘Parenting Early Intervention Pathfinders’ initiative). Many managers and practitioners are hesitant, however; the programs are ‘too American’ (many have actually been developed or at least implemented elsewhere) and they appear to threaten professional autonomy and existing services. Surprisingly little attention has been paid to this latter issue, which concerns de-commissioning, so that services often accumulate in an uncoordinated fashion or simply fizzle-out when grants end.ReferencesAdamson P. (2007) Child poverty in perspective: an overview of child well-being in rich countries, Innocenti Report Card 7, UNICEF Innocenti Research Centre, Florence.Barlow, J., Simkiss, D. and Stewart-Brown, S. (2006) ‘Interventions to prevent or ameliorate child physical abuse and neglect: findings from a systematic review of reviews’, Journal of Children’s Services 1 (3), 6-28.Farrington, D. P. (2003) ‘A short history of randomized experiments in criminology: a meager feast’, Evaluation Review 27 (3), 218-227.Hutchings, J., Bywater, T., Daley, D., Gardner, F., Whitaker, C., Jones, K., Eames, C. & Edwards, R.T. (2007) ‘Parenting intervention in Sure Start services for children at risk of developing conduct disorder: a pragmatic randomised controlled trial’, British Medical Journal, doi:10.1136/bmj.39126.620799.55 (9th March).

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