Early intervention is a loosely-defined term that refers to taking action to resolve problems as soon as possible, before they become more difficult to reverse. In this Report, we consider early intervention in relation to childhood adversity and trauma, to tackle the potential long-term problems that those who encounter such experiences are more likely to encounter.
Adverse experiences in childhood, such as abuse, neglect or difficult household situations, are associated with an increased risk of health and social problems in later life, with the prevalence of a range of these problems increasing with the number of adverse experiences suffered. Around one in every two adults in England is thought to have suffered at least one adverse childhood experience. There are, however, an increasing variety of early intervention programmes that have been shown to improve life outcomes for those affected by childhood trauma or adversity, while also saving long-term costs for the Government.
Despite the opportunity presented by such interventions, their provision is fragmented and highly variable across England, with inadequate effective oversight mechanisms for the Government and others to monitor what local authorities are delivering. There is no clear, overarching national strategy from the UK Government targeting childhood adversity or early intervention as an effective approach to address it. Co-ordination between the different Government departments whose areas of responsibility relate to childhood adversity or associated problems could be improved.
Where local authorities are not providing early intervention based on the best available evidence, vulnerable children are being failed. There is now a pressing need for a fundamental shift in the Government’s approach to early intervention targeting childhood adversity and trauma. The Government should make early intervention and childhood adversity a priority, and set out a clear national strategy to empower and encourage local authorities to deliver effective, sustainable and evidence-based early intervention. The Government should also ensure that it has better oversight of the provision of early intervention around the country, so that it can identify approaches that are working well, detect local authorities in need of support and hold local authorities to account.
The collection and analysis of appropriate data can help to monitor the impact of early intervention initiatives to ensure that they are achieving the desired effect and to inform further improvements, as well as to support the identification of families that may benefit from early intervention. The new strategy should support local authorities in this, including by:
The new strategy should also recognise the scope for improved awareness of the importance of adverse early years experiences on child development, and knowledge of the latest science in this domain, across the early years workforce. The Government should ensure that the accreditation criteria for social workers include knowledge of child development science, the impact of adversity and methods for addressing this, as well as good practice in collecting and using data. It should ensure that training is available to allow social workers to meet these criteria throughout their career.
The Government should also review the training curricula for other professions, such as teachers, health visitors and police officers, to achieve similar levels of knowledge across the early years workforce. The new national strategy must make clear that in commissioning evidence-based programmes, local authorities should ensure that there is sufficient accredited, ongoing, specialist supervision from qualified supervisors in that programme for the workforce, throughout the delivery of the programme. The Apprenticeship Levy offers an important potential source of new funding for training of the early years workforce. The Government should promote the opportunity presented by the Apprenticeship Levy as a source of funding for training early years practitioners.
Implementation science is a developing field focusing on methods and strategies that improve the uptake in routine practice of new interventions that have been found to be effective. The Government should ensure that its new national strategy for adversity-targeted early intervention incorporates the latest evidence from implementation science, as well as lessons learned from services that have successfully implemented evidence-based early intervention with positive outcomes.
In adopting a new national adversity-targeted early intervention strategy, the Government should see effective early intervention as an opportunity to save costs—as well as to improve people’s lives—rather than a demand on resources. The new strategy should seek to drive a shift in the focus of current expenditure from ‘late interventions’, required where problems have escalated, to earlier intervention. Although this may require an initial increase in expenditure, there is good reason to expect this to lead to long-term savings across diverse sectors. These are reasons why central Government is best-placed to provide funding for early intervention initiatives. Local authorities and their partners should nevertheless be bold with the resources they have and invest in sustainable delivery of early intervention to save costs down the line.
As part of a new national strategy for evidence-based early intervention, the Government should review funding for the Early Intervention Foundation, to ensure that it has greater long-term security, and so that it can achieve for local authorities what the Education Endowment Foundation has achieved in schools. Local authorities would benefit from the support of a central specialist team with experience in effectively and sustainably implementing early intervention programmes, to help with planning and delivering evidence-based early intervention and to overcome the various challenges we have identified. An expanded Early Intervention Foundation would be well-placed to host such a team, and the Government should invest in the Foundation to achieve this aim. The Early Intervention Foundation should identify local authorities willing to become ‘Early Intervention Places’, which would receive particular support from the new specialist team. Together with the central team, these local authorities would utilise implementation science to build sustainable implementations of evidence-based programmes, simultaneously generating new knowledge that can be rolled out to other local authorities at a pace consistent with the development of sustainable service transformation.
Published: 14 November 2018