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Early Intervention

Early Intervention

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Early Intervention

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Presentation Transcript

  1. Early Intervention Key themes and issues

  2. Thinking about early Intervention • EI to mirror life span development principles? • Multi-dimensional and directional • Plastic and malleable – different paths • Culturally & historically embedded • Contextual – interaction, agency & narrative • Weave of moral, medical & economic themes

  3. EI – the state context • Nordic – universal, high tax, less poverty • 12-36 months m(p)aternity paid leave • Anglo – means tested, targeted, markets • Pre-school Japan-US, Denmark/France • Pedagogical role, status of care staff • Class size, education-care & early years • Childhood as culturally contested?

  4. EI – the mode • Illness, disorder, neglect, pre-school, parenting, home visiting • child development, empirical, ecological • Medical & social models – integrating? • Prevention & early years - assumptions • Too little too late for the rest? • Early engagement in the problem • Quality as important as timing

  5. EI – key questions • At right point re – development or transition • At right time re - some risk or harm • At right setting – informal-formal • With right theories / services / strategy • With right skill mix of front-line and specialist • With right citizens and user participation • With right accountability & governance

  6. The evidence? • Long-term does EI build better adults? • Short-term – safety, health, wellbeing • Mother’s self esteem, parenting, emp. • Head-Start – effective re-outcomes/costs • Large multi-part schemes – what works • Small schemes good impact –roll out? • Ethical, financial, long-term impact?

  7. EI to prevent mental health problems • Early intervention for wellbeing-inclusion • EBD more successful early on – late-poor • Conduct disorder- by age 28 consume 10x • Less severe MH by age 28 consume 4x • 20% with significant probs - MH specialist • 60-70% don’t get right services early on • Children looked after, exclusions, courts

  8. Mental health & child development • Wide range of interventions (Barnes 2002) • EI valuable early as possible – pregnancy • Mix of quality, intensity, extended period • Multiple elements – not just on conduct • holistic, flexible, systemic – EI to mainstream • Trust, cultural awareness, non-stigmatising • Practical and crisis support – (Fonagy 2004)

  9. Risk, protection & prevention paradigm • Risks, resilience, strengths, dynamics • Risk factor clusters more important – • Risks not predictive of future behaviours • Promote protective: bonds, affirming, skills • Risks as salient at different times & contexts • Intersection of risks and transition points • ‘Pathways to prevention’: family peers school

  10. Some concerns • Deprived fare disproportionately re quality • Wary that short-term can offset life-long. • Intervention works OK – but will it work here? • Yesterday’s measures & values still OK? • Policy turbulence – confounds measure? • Sure Start – EBP or PBE?? • Continual revolution with no history

  11. EI as system thinking – CAMHS? • Who should intervene early? Cascade skills? • psychs, paeds, scarce & sometimes reluctant • EI special projects seen as luxury enclave • EI robs mainstream? See the same kids!? • Mainstream crisis? EI is rationed serendipity • EI as system imperative – new narrative • EI needs skilful system co-ordinator

  12. EI as spin, IT-fix & common sense • Intrusive, ineffective, harmful – tariff raised • Youth justice – actuarial, selective measures • Pre-offending, non-pro social flagged up • Choice & responsibility = inadequate grasp • Return to social capital, rights & opportunities • Uncomplicated belief that ‘work’ is answer • Communities without shared past of future

  13. Governance and EI • Expectations – procedures metrics time-lines • Practice now visible & disciplined – success? • Management data – ironies of automation • Technology & unrelenting acceleration • Audit Commission – ‘take more time’ (VC) • Audit Commission – publish league tables! • EI & the user - a surface gloss on power

  14. Reasons to be cheerful? • Body of knowledge incomparably greater • Much more aware of risk, resilience, process • Evidence from many effective programmes • Inter-disciplinary – methodologically open • Willing to doubt • No single all-pervading view • Willing to challenge mono-causal claims

  15. EI – research questions • Multi-disciplinary research - benchmarking • EI - treatment & organisational hypothesis • Costs and cost effectiveness • Early for who? Assessment and technology • Dynamic interplay of child, family, community • Mainstreaming the skills • The ecologies of children