Evidence-based early years intervention Contents

Conclusions and recommendations

The evidence behind early intervention

1.Research into adverse childhood experiences (ACEs) has usefully raised awareness of the importance of early years experiences on child development, and of the potential consequences associated with childhood adversity or trauma. The ACE framework helps to provide a common language for early years practitioners working in different sectors. However, the simplicity of this framework and the non-deterministic impact of ACEs mean that it should not be used to guide the support offered to specific individuals. (Paragraph 17)

2.There is now a body of evidence that clearly demonstrates a correlation between adversity suffered during childhood and an increased prevalence of health and social problems in later life. Despite a variety of proposed explanations for this correlation, the causal pathways linking childhood adversity or trauma to subsequent problems are less certain. Nevertheless, when delivered effectively, there is strong evidence that early intervention can dramatically improve people’s lives and reduce long-term costs to the Government. The Government should ensure that it is making the most of the opportunity for early intervention to effectively and cost-effectively address childhood adversity and trauma, and the long-term problems associated with such experiences. (Paragraph 25)

3.Important research questions regarding childhood adversity and early intervention remain. Progress on this front would benefit from a more co-ordinated approach across different academic fields, as well as greater access to relevant administrative data held by the Government. As it starts working towards its goal of improved interdisciplinary collaboration, UK Research and Innovation should co-ordinate research into child development and early intervention methods for addressing childhood adversity, across different academic disciplines. Particular focus should be on developing interventions to address adverse childhood experiences for which no effective intervention has been demonstrated, including sexual abuse, parental substance misuse or parental incarceration and crime. (Paragraph 31)

4.Further, we recommend that the Government should ensure that academic researchers can access Government administrative data relevant to childhood adversity, long-term outcomes and the impact of early intervention, while ensuring appropriate privacy and safeguarding mechanisms are in place. UKRI should consult the relevant academic community to determine which data would be beneficial, and work with Government departments to ensure researchers can access that data as appropriate. (Paragraph 32)

The current state of early intervention in England

5.Whilst there is evidence of good practice in some local authority areas in England, there is no clear, overarching national strategy from the UK Government targeting childhood adversity and early intervention as an effective approach to address it. Nor does there seem to be effective oversight mechanisms for the Government or others to monitor what local authorities are doing. This has led to a fragmented and highly variable approach to early intervention across England, with evidence of a significant gap between what the latest evidence suggests constitutes best practice and what is actually delivered by many authorities. Where local authorities are not providing early intervention based on the best available evidence, vulnerable children are being failed. (Paragraph 45)

6.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 match the ambition of the Scottish and Welsh Governments, and build on the example set by certain English councils, to make early intervention and childhood adversity a priority, and set out a clear, new national strategy by the end of this Parliamentary session to empower and encourage local authorities to deliver effective, sustainable, evidence-based early intervention. (Paragraph 46)

7.The Government should 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. It should determine what information is needed to be able to assess the local provision of early intervention and set out a framework as part of the new national strategy that ensures that all local authorities will provide such information, with as little disruption to their working practice as possible. (Paragraph 47)

8.Co-ordination between the different Government departments whose areas of responsibility relate to childhood adversity or problems associated with this could be improved. We welcome the formation of the new ministerial group working to improve family support for those with young children. This group should: make tackling childhood adversity a focus of its work; improve cross-Government co-ordination on this issue; and ensure that there is clear accountability for driving this agenda across all Government departments. (Paragraph 48)

9.The Healthy Child Programme is the only mechanism in place through which all children in England should receive early years practitioner support before the age of five. Its coverage is therefore critical for identifying ACEs and other child development issues early. The Government should review the current provision of the Healthy Child Programme across England and set out, as part of the new national strategy, a date for achieving complete coverage in the number of children who receive all five mandated health visits. Given existing workforce pressures, the Government must ensure that this required increase in coverage does not negatively impact the quality of health visits. It should consult the Institute of Health Visiting on how this can be managed, and be ready to recruit additional health visitors as required. (Paragraph 54)

10.There appears to be significant concern within the early years community at the outcomes for assessment chosen by the then Department of Health for the major study it commissioned of the Family Nurse Partnership. We therefore do not encourage national or local Government to act upon the study’s overall recommendation to discontinue provision of the Family Nurse Partnership. Nevertheless, the study’s findings should be considered, and where they can be used to improve the impact of the Family Nurse Partnership programme such action should be pursued. We commend the Family Nurse Partnership National Unit for implementing its ‘ADAPT’ initiative to learn from the study’s findings, and we urge local commissioners and providers to act upon the conclusions reached by this initiative. (Paragraph 59)

11.Although we commend the Government on its willingness to commission a significant study of the effectiveness of the Family Nurse Partnership, such studies are only of value if their findings are widely supported and acted upon. The provision of evidence-based early interventions will clearly benefit from studies that can provide a strong evidence base. If the Government commissions future major studies of significant early intervention programmes—which we would welcome—it must ensure that the outcomes it decides are to be assessed, and other elements of the design of such studies, are supported by the early years practitioner community. The Government must then act upon the evidence generated by those studies. (Paragraph 60)

12.The delay in launching a consultation on the future of Sure Start Centres is regrettable and has meant that Ofsted has not inspected children’s centres since 2015. Local authorities have been left unsure of the status of children’s centres in future policy. The Government should clarify its position on Sure Start centres. In response to this Report, it should specify if—and when—it intends to hold a consultation. If it intends to proceed with a consultation, this should be held within three months. The Government should also set out the focus and purpose of such a consultation. If a consultation is not going to be held, the Government must urgently reinstate Ofsted inspections of children’s centres and make clear its thinking on the role and value of children’s centres. (Paragraph 64)

13.We welcome Minister Doyle-Price’s ambition to do more in this area. However, there was a disappointing level of ambition and focus on pre-school aged children in the Government’s 2017 Green Paper on ‘transforming children and young people’s mental health provision’. As it develops its action on children and young people’s mental health, the Government should recognise the importance of child development and the impact of adversity in the early years, and ensure that it adopts ‘transformative’ ambitions and policies for pre-school aged children alongside its work targeting schools and colleges. (Paragraph 68)

14.Prevention of mental health problems can start before signs of low mental wellbeing start to appear, through promotion of healthy mental wellbeing to all children. The Government should set a policy for primary and secondary schools that seeks to promote wellbeing as well as improving the early identification of, and support for, emerging problems. (Paragraph 70)

15.There are a variety of programmes beyond the Healthy Child Programme, the Family Nurse Partnership and the Sure Start initiative that reach children who are experiencing or have experienced adversity and trauma. However, none of these programmes specifically target these children and they do not prioritise preventing ACEs or mitigating their effect. This reinforces the need for the Government to develop a new national strategy specifically focusing on childhood adversity and trauma, and on evidence-based early intervention initiatives that can address these issues. (Paragraph 73)

16.There is an opportunity for the Government to increase the provision of evidence-based early years programmes, without increased cost, by setting more prescriptive specifications on the content of childcare eligible for Government funding. The Government should work with researchers and practitioners to examine how new specifications on the free childcare it funds could increase the use of evidence-based programmes, and what the impact would be on the families affected. Such specifications could rapidly increase the number of families receiving evidence-based programmes and we call on the Government to review this by the end of this Parliamentary session, although local providers should be given a period of time to adjust to any new specifications. (Paragraph 74)

Key Challenges to Delivering Early Intervention

17.Despite the long-term savings associated with effective early intervention, the amount of funding available to local authorities that is nominally destined for early intervention is declining. This can result in early intervention activity being sacrificed in favour of statutory duties, in addition to the commissioning of cheaper, unproven interventions as well as a reluctance to properly evaluate interventions that are being delivered. Nevertheless, funding constraints should not be used by local commissioners and others as an excuse to avoid acting upon the latest evidence regarding childhood adversity and early intervention—especially given the savings that some programmes can deliver for local authorities, particularly in the long-term, and given the positive impact on the life chances of children. (Paragraph 82)

18.The collection and analysis of appropriate data is vital to monitoring the impact of early intervention initiatives to ensure that they are achieving the desired effect and to inform further improvements. It can also help to identify families that may benefit from early intervention. Despite these critical uses, the local collection and analysis of data is not conducted as widely or as thoroughly as it should be around the country. Collation of relevant data at a national level is also insufficient, with fewer than half of local authorities submitting data on the five mandated visits of the Healthy Child Programme to NHS Digital. Public Health England’s public health indicator data does not appear to include any measures sufficiently focused on childhood adversity or early intervention. The early years are a critical period for child development so it is unacceptable that there is no national system of data collection assessing such development before the age of two. Two years on from the publication of the Government’s ‘vision’ for children’s social care, it is clear that there is still significant work to be done to achieve its aim of making full use of data in the early years system. (Paragraph 88)

19.Local authorities and their partners face a combination of challenges in collecting, sharing and interpreting data relevant to childhood adversity and early intervention. These include a lack of capability or capacity, as well as problems with sharing data between different services and systems. However, robust data collection and analysis is critical to the delivery of effective evidence-based early intervention. Although data collection can be time-consuming, it can improve frontline practice and—implemented properly—lead to efficiencies elsewhere. (Paragraph 92)

20.The establishment of Social Work England constitutes an important opportunity to review the training given to children’s social workers. 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. The knowledge required should be tailored to the different roles and responsibilities of practitioners, supervisors and leaders. The Government must further ensure that training is available to allow social workers to meet these criteria. (Paragraph 99)

21.There is scope for improved awareness of the importance of early years experiences on child development, and knowledge of the latest science in this domain, across the early years workforce. The capacity and motivation to engage with evidence should also be improved, in particular for those in leadership positions. The establishment of Social Work England constitutes an important opportunity to review the training given to children’s social workers, but the early years workforce encompasses a much broader range of professions than social workers alone. (Paragraph 104)

22.Although many organisations report that intervention outcomes benefit from families receiving support from the same practitioner throughout their interaction with a particular service, constraints in capacity are a major contributory factor resulting in many services not consistently achieving such continuity of care. (Paragraph 107)

A new national strategy

23.The Government’s new strategy for adversity-targeted early intervention should include plans to improve the use of data for assessing early intervention and identifying families who could benefit from early intervention, at local and national level. The strategy should promote the value of data collection and analysis by drawing on case studies of local authorities or their partners using data to improve outcomes. It should also set out the general principles of good practice with data collection and analysis, such as collecting baseline data in preparation of assessing a new intervention and avoiding the use of self-reported measures. (Paragraph 115)

24.The new strategy should set out what local authorities should measure to assess their early intervention initiatives or to identify families who could benefit from receiving early intervention support, and give examples of specific data that would capture this. These measures should be identified in consultation with child development experts and local authorities themselves, and cover aspects such as social, emotional and language development from birth through to the start of school. Consideration should be given to the burden of collecting the data and the compatibility of its collection with existing practice. In identifying these measures, the Government should ensure that it seeks opportunities for local authorities to make use of data that they or their partners already collect. (Paragraph 116)

25.The new strategy should also address challenges in data-sharing between different organisations working with young children. It should include guidance to local authorities and their partners on data protection legislation and provide examples of best practice in data sharing, focusing specifically on childhood development, trauma and related early interventions. The Government should additionally consider what infrastructure and licences could facilitate efficient, interoperable data processing by local authorities and assess the cost-benefit of providing funding towards this. (Paragraph 117)

26.Collection of the most important data at a national level would provide central Government with information on the national state of childhood adversity and early intervention, and drive local authorities to ensure the necessary data is collected. Children are not currently assessed with a national measure of child development until the Ages and Stages Questionnaire at age two to two-and-a-half. In addition to ensuring full coverage of the health visits mandated by the Healthy Child Programme, the Government must ensure that the data collected during such visits is reported nationally. It should consult the Institute of Health Visiting and child development experts to determine if the Healthy Child Programme should include assessments of social and emotional development prior to the fifth mandated visit, and if so provide the resources necessary to allow for this. (Paragraph 118)

27.The new adversity-targeted early intervention strategy should also set out measurable objectives for progress on data collection, such as the proportion of local authorities supplying full data from the Healthy Child Programme mandated visits, or the proportion of local authorities identified by Ofsted as delivering sufficiently data-driven early intervention. If data collection and analysis does not consequently improve within two years of the strategy’s implementation, the Government should consider introducing statutory requirements for the reporting of data that can be used to monitor the delivery and impact of early intervention. (Paragraph 119)

28.The Government’s new national strategy for adversity-targeted early interventions must include steps to increase the knowledge that professionals across the early years workforce have of: the impact of childhood adversity or trauma and what can be done to remedy this; how to identify those families that could benefit from early intervention; how to access and use relevant, up-to-date scientific evidence; how to make best use of data in offering and delivering early intervention services, and in understanding and evaluating the effectiveness of those services; and child development and the importance of early years experiences. The strategy should identify and define the ‘early intervention workforce’, comprising the full range of professions that engage with young children or their families and that could either: help to identify those who would benefit from early intervention; or would play a role in delivering early intervention services. The Government should then review the pre-qualification training and continuing professional development offered to the different professions in the early intervention workforce and ensure that each covers the different elements outlined above, at a level appropriate to the profession in question. (Paragraph 122)

29.Many evidence-based interventions require ongoing, accredited supervision from specialist supervisors with expertise in that particular model. As part of a new national strategy for adversity-targeted early intervention, the Government 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. Local commissioners should aim to support the development of their own accredited supervisors, to enable cost-savings and deliver an experienced and expert workforce, leading to greater sustainability. (Paragraph 125)

30.The Apprenticeship Levy offers an important potential source of new funding for training of the early years workforce. The new adversity-targeted national strategy should promote the opportunity presented by the Apprenticeship Levy as a source of funding for training early years practitioners. The Government should monitor the number of local authorities that make use of the Levy in this way, evaluate the impact where authorities have used it, and provide guidance to assist other local authorities in using the Levy funding if it proves to be successful. (Paragraph 127)

31.Implementation science is a developing field that can inform the delivery of service transformation programmes, to increase the chance of successful implementation and sustainability. In addition to the focus on data-driven practice and the delivery of relevant training and ongoing expert supervision, the new national strategy for adversity-targeted early intervention should encompass the latest evidence from implementation science, incorporating elements such as a commitment to model fidelity and the adoption of realistic timeframes for service redesign and deadlines for results. The Government should consult academics and practitioners to achieve this, and ensure that lessons from services that have successfully implemented evidence-based early intervention with positive outcomes are also taken into account. (Paragraph 132)

32.As the What Works Centre established to review the evidence relating to early intervention and to help disseminate the latest findings to relevant stakeholders, the Early Intervention Foundation has a key role to play in improving the provision of evidence-based early intervention in England, and should be a key partner to Government in developing and implementing the new national strategy. As part of the forthcoming Spending Review, the Government should review funding for the Early Intervention Foundation with a view to increasing and extending it, to ensure that the Foundation has greater long-term security, and so that it can meet the Children’s Minister’s aims of achieving for local authorities what the Education Endowment Foundation has achieved in schools. (Paragraph 138)

33.In working to deliver on the new adversity-targeted early intervention strategy, 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. (Paragraph 139)

34.We have heard strong arguments for the improved provision of evidence-based early intervention targeting childhood adversity and trauma in England. Nevertheless, we recognise that open research questions remain and further lessons about the real-world delivery of early intervention can be learnt. The new national strategy should be targeted at, and acted upon by, all local authorities. In addition to this, the Early Intervention Foundation should identify local authorities willing to become ‘Early Intervention Places’, which would receive particular support from the central, specialist team we have recommended. 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. (Paragraph 141)

35.In adopting a new national adversity-targeted early intervention strategy, the Government should see effective early intervention as an opportunity to make long-term cost efficiencies—as well as improve people’s lives—rather than a demand on resources. The Government should correspondingly make the necessary funding available where elements of the new strategy will require funding from central Government. The new strategy should also seek to drive a general shift in the focus of current expenditure on ‘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. The new strategy should seek to identify ways in which the cost of early intervention can be brought down without compromising its effectiveness, for example by reviewing the evidence for digital early intervention services, as well as considering how local authorities can be incentivised—rather than penalised—for making long-term investments. Where local authorities cannot invest in early intervention initiatives that are expected to deliver long-term cost-benefits, the Government should be ready to provide additional funding to ensure the opportunity to improve lives and save public money is not missed. (Paragraph 146)

Published: 14 November 2018