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A definition of Early Intervention can be to engage in childrens and young peoples life at the earliest possible stage, regardless the fact that a problem has already emerged or not, using mainstream/ universal or targeted/ specialist services. In the first place, Early Intervention programmes provide and support children and young people with appropriate equipment (social, emotional, physical) to start or continue their life with the best chances becoming better parents in the future, for example Childrens Centre for Early Years, SEAL and PATH programmes in Primary school, Life Skill Training programmes in Secondary schools. In the second place, Early Intervention programmes provide support as soon as there is evidence that a child is or may be in need, so the situation need to be resolved at the earliest possible preventing more harm. For example, Safer Families Project where domestic abuse and conflicts are present in the family without reaching the social care intervention threshold, Family Nurse Partnership provided to the first time mothers meeting the criteria, Functional Family Therapy for young people with early symptoms of behaviour disorders. The programmes can be offered to either all children or targeted ones.
Early Intervention does not refer only to Early Years as childrens and young peoples needs may occur during several stages in their life, for example during transition or transfer from the primary to secondary settings, after a difficult and life changing situation like a death of a parent or teenage pregnancy.
According to the literature, Early Intervention provides beneficial outcomes to children, family and community; maximizes the childs and familys chances for success, provides lasting benefits in childrens life, prevents persistent social problems, social exclusion and damaging parenting and is cost-effective with long term public savings (Allen, 2011, Pithouse 2007, Barnes and Freude-Lagevardi 2002; Early Intervention: Securing good outcomes for all children and young people, 2010). In a sense it is about “break in a causal chain” (Pithouse, 2007), and we can achieve this by making children ready for school, ready for secondary school and ready for life (Allen, 2011; Allen and Smith 2008). It is, also, mentioned in Support and Aspiration: A new approach to special educational needs and disability (2011) that key aspects for childrens future success are the early identification of a problem and timely engagement and support. Moreover, independent reviews (Munro 2011, Field 2011, Allen 2011, Tickell 2011) have concluded that it is important to provide support at the earliest possible opportunity so as to improve a childs life. Even if a problem appears later than early years, early intervention means to deal with the problems as soon as possible.
Factors for effective Early Intervention
According to Doyle et al (2007) quality, dosage (intensity), timing, service orientation, differentiated benefits (able to recognize risks and address childrens multiple problems) and continuity of support (long lasting) are basic factors making Early Intervention programmes effective. Pithouse (2007) adds to this list that Early Intervention programmes need to be preventative, protective, holistic, flexible, no stigmatizing and able to build trust and provide long term beneficial outcomes.
Holistic Considering Early Intervention, we need to take into account children and young peoples context that is family and community. For example, in several cases, school attendance and behaviour are connected to issues related to family, school and community factors like parents/ carers out of employment, young carers, looked after children, high rate of community crime or gang activity. There are little chances to reach our outcomes, if we try to resolve attendance and punctuality concerns in one dimension omitting the multidimensional aspect of the problem.
According to Taylors recommendation (2012) for improving overall school attendance, we need to focus on and identify vulnerable pupils since primary school years (even nursery and reception), who raise concern and support parents who fail to get their child to school regularly. According to the Government (Gove, 2012), the main concept is to get students into good habits of attendance from an early age; which along with punctuality are important skills for their future professional life and benchmarks to maximise the opportunities to achieve their potential.
Long Lasting In Early Intervention: Next Steps (Allen, 2011), a number of programmes are presented which have been evaluated by specific standards and selected by their effectiveness and cost effectiveness. Still there is work to be done to improve, evaluate and apply them to national level. In general, regarding early intervention we need to wait for the long term effects to be present. For example, as Pithouse (2007) mentions the effectiveness of Sure Start pre-school programmes cannot be evaluated as the Government will replace them with Childrens Centre services. It is, though, important support to be provided after the intervention stage is completed to maintain the benefits and positive outcomes (Doyle, 2007).
Preventative According to Pithouse (2007), prevention is better than cure. It is well stated in Allen (2011), that English policies have funded millions in later intervention; however early intervention is cost effective with pay offs. It is also summarized in Making Sense of Early Intervention: A Framework for Professionals (Centre of Social Justice, 2011) that there is a need of commitment to prevention.
Timing Moreover, intervening early to childrens life provide better benefits in long term. Considering Early Years, early childhood is a key period for cognitive, brain and emotional development and if issues are not resolved during early years then later attempts are less likely to succeed (Allen and Smith, 2008). However, Government may be slightly oriented to Early Years (Her Majestys Treasury et al., 2006) we need to focus and engage early in childrens life and all professionals working with children, young people and families need to be able to notice the early signs of a problem and be adequately trained either to provide support or refer the case.
As mention above, within the idea of early intervention, multi-agency working is most of the times needed to address and identify needs, to implement strategies and provide support to child and his family.
The strategies of the early intervention implemented in each country, though affecting each other and based on same needs for children (illness, mental health, family, pre-school support, attainment) are part of the welfare system and defined by economic and cultural factors. There are for example the universal systems and the more targeted systems, differing on the physical and ideological nature of provision. The history and culture of the country and the definitions of normality, for example the structure of the childhood, the meaning of a good citizen define the strategies that take place and the targets that need to be met (we intervene in a childs and young persons life to provide support and guide them to a better future according to the societys standards)
One of the questions rising is after the recognition of risks and problems how we can evaluate the depth and the immense of the problem identifying the child and the services we need to provide, and how we select the child, according to which selection criteria, is he/she the right person or they are the ones asked for the programmes? For example, in a school environment a child being polite and quite may slip through the net; when there are problems we need to make professional decisions following the standards put by the school, community, government. Following, by the intensity of the provision; it will be a long term or short intervention? Also, we need to take into account the timing of the intervention and whether a proposed intervention is feasible in a communitys context and nature. Another, basic question is about the quality of the programme and how flexible it can be. As we talk about individuals needs, the targeted programmes need to be as personalised as possible to meet the childs needs. From my perspective, it cannot be one programmes fits all. Taking into account, the school community, with a small number of 700 students, and 100 students with attendance concerns; it happened to have 50 different personal attendance plan for each of them as each one had specific needs. How feasible is that to happen nationally (Education and Health plan); however, time and resource consuming it is small units may worth applying identified action and progress plans. Check QUALITY. Regarding the long lasting effect it is hard to have a general yes answer as we have narrow trials, but we can use the example of US Head Start pre-school. Finally, as we have already mention, a programme need to be holistic taking into account the childs needs, physical, emotional, social development, strengths and weaknesses and, also, taking into account family and community aspects.
Sometimes people receiving targeted services feel stigmatised and it is better these services to be provided universally, however it may be costly. Now, if we invest in early years then less and less targeted services will be used in the future.
We can notice the governments aspiration to support families through projects like Safer Families, Family Focus, Childrens Centres (support to parents), and Family Nurse Partnership etc. Moreover, the new CAF orients to a whole family approach rather than child one.
Finally an important factor is trust and good relationship, shared decision making and cultural background so children and families can rely on the professional (see also the paper of the view of young people)
According to Pithouse, there is positive evidence for small innovative programmes regarding short and intermediate outcomes for child health, safety and wellbeing and for parent self-esteem, parenting and parent employment.
There also the following questions to be asked (1) Who does What, when, where, with whom and how we ensure that it happens (2) how we disperse the available resources and dispose them to have the desired impact (3) are we looking for short term, intermediate or long term benefits (4) decide which of the strategies in what time were effective and successful. As early intervention is a multifaceted approach
Finally, we need to take into account the relationship between universal/ mainstream and targeted services and the relationship between information technology and frontline workers.
As the pressure on professionals is increasing to meet targets and provide beneficial outcomes, there can be challenges in the relationship between universal and specialist services. For example, universal services claim that due to resources they can provide standardize and brief services however they could provide more if they have the appropriate resources and workforce, which prefer to be employed by the targeted services. At the end, children return to mainstream after the targeted services, however there is need to sustain balance and mutuality between mainstream and targeted services to sustain the gains from the provision.
Regulatory framework of assessment procedures, metrics and timelines, electronic monitoring, information sharing claim their capacity to help us react early, swiftly and transparently however is early intervention applied? Can early intervention be delivered in front of a computer rather than by front line workers? Is information reaching the front line practitioners or stays in a loop for managerial aspects? Can complex human problems be identified by computers? Are all practitioners accessing computers to share their information? Who is accessing the information, is family under surveillance? The benefit is that early needs may indeed be identified early and we can monitor if services are responding. We can check if services were timely and commensurate however we cannot check if intervention met a set of human encounters.
As we have already mentioned, early intervention needs to consider childrens ââ‚¬” family – community outcomes. For example, we cannot improve a childs attendance when he is a young carer with one parent on drugs without any provision provided form the community; for every action taken we need to take into account this childs context. France and Utting (2005), proposed a more flexible and multi layered approach based on risk and prevention focused intervention. Our aim is to minimize and reduce risks factors and incidents of future problems via strategies that support and protect children. We need to promote resilience to children through strengthening the bonds among children, family, school and community and rewarding positive behaviours. The challenges of this approach are the timing, process and setting of the strategies and also the closeting, duration and intensity.
In the UK, work is under progress so this programme has universal and effective aspect as strategies have been taken nationally (ten years plan to improve and promote services ââ‚¬” Every Child Matters, Department of Health and Department of Education and Skills 2004), regionally (multi-agency joined up working and partnership for childrens services) and locally (community based children services, extended school, family focus and support).
From the above initiatives we need to wait to see if there is evidence of benefits reducing children misfortune. For example the initiative for extended child care helps mother to get back to work. However, is that a good benefit or young children miss attachment?
Intervention programmes so far are based on UK and US studies, however we need to have clear proof of what work in there will be a new policy. (Allen, 2011). It may be politically and morally uncomfortable to wait but it is better to have assurance rather than assumption of benefits.
From a professionals point of view, early intervention is effective and provides benefits, however from a users point of view early intervention can be thought as invasive (justified by all when urgent protection is needed), ineffective and wasteful, for examples when benefits are not immediate, harmful, as users can be stigmatised and expensive, considering this money to be provided in a different urgent service. For example, students feel ashamed when parents come to school to discuss concerns and there are examples of parents refusing to come due to not be stigmatised that there is a problem. Another example, from our Extended School is that parents are reluctant to engage as there are no obvious immediate benefits for their child. A proper campaign and rise national awareness about early intervention and available services need to be on top of governments agenda.
Early intervention needs to take into account childrens right, provide participative dialogue, tackle systemic inequalities and build social capital (trust, commitment, and adherence to socially approved and legitimate norm). This can lead to minimizing crime and maximizing social stability.
There is a need for an integrated prevention paradigm taking into account the child, the family and the community. Government is in favour of prevention and early intervention (Early Intervention Grant, Early Intervention Foundation) however children are still slipping through the net as our main concerns were reorganisation, network coordination and information sharing and not provide the basics to our children. As it is made obvious from the above, multi-agency working needs to be supported and reinforced to provide effective services.
We need to support strategies that they can lead to solidarity supporting each other, minimizing social exclusion and dysfunction, investing in the social capital as, especially in the UK, communities are multi-ethnic and multi-racial with fewer and more subtle relationships among its members. The effects of economic and global culturalization had changed the demography, identities, competences and life pathways so we need to learn about the children and their experiences. We cant think the same cases that we thought twenty or even ten years earlier. Early intervention and early years services need to take into account shared identities and solidarity and they need to be mentioned in policy.
As we have already mentioned, early intervention programmes need to take into account the wider problems of family instability, community decline and youth disorder.
Knowledge of children in need is bigger and better; issues of risks and resilience are more familiar; importance of working together; there is a small but robust evidence for effective early intervention; early intervention needs to engage with children and families in multiple ways and levels; multidisciplinary practice and research should be high on the policy agenda; in the US clear cost benefits from early intervention, now studies are conducting in the UK.
Our meta-policy challenge of our era is with what idea, from where and with whom we will co-construct better practice to meet the challenging needs of children. There is need for more comparative policy research, national benchmarking and peer review of initiatives in other countries.
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