Presentation on theme: "Notes from Michael Little’s presentation These notes refer to some of the points Michael Little made during his presentation at the Cumbria, Lancashire."— Presentation transcript:
Notes from Michael Little’s presentation These notes refer to some of the points Michael Little made during his presentation at the Cumbria, Lancashire and Cheshire Children’s Fund Meeting Much of the data and discussion about the well-being of children in UK and the impact of prevention innovation since 1997 are contained on the Prevention Action website, a daily publication covering breakthroughs in prevention science and application to policy and practice. Prevention Action also contains valuable resources such as databases of good practice, and links to other reliable sources around the world. It can be read at
Another helpful way of thinking about innovation is to consider possible chains of effect that may lead to the outcome to be improved. For example, one of several routes to anti-social behaviour is poor housing, that leads to parental depression, that reduces the quality of parenting, which in turn contributes to anti-social behaviour. The idea is represented in the following diagram.
Many interventions for anti-social behaviour are focused on treating the symptoms and working with the child. An alternative logic would be to reduce risks that lead to anti-social behaviour. In the following illustration, all the interventions are focused on reducing risks, and all concentrate on adults, although the major beneficiary is intended to be the child, and their reduced anti-social behaviour.
Another way to think about the problem is to break the chains that connect the risks. The following example assumes that nothing can be done about the poor housing or the parental depression. After-school support takes the child out of home for longer periods. Quite apart from any direct benefits it reduces over-crowding for parts of the day. Mentoring that offers one-significant adult (OSA) into the child’s life may break the next part of the chain.
The presentation indicated several sources of information about proven models from around the world. Some are listed on the reference page of the Prevention Action site. The Blueprints for Violence Prevention site is extremely helpful, and lists just 11 programmes that meet strict inclusion criteria. The Best Evidence Encyclopedia is a good source for education programmes.
Proven models from elsewhere rarely provide the answer to local problems. But much can be learned from the way in which other people have gone about designing services and from the logic that underlies the approach. It is depressing that so little of the innovation in the last decade has resulted in programmes that carry the features of effective prevention services, such as: Clarity about the target group and the risks to be reduced A clear logic model and realism about impact on outcomes A statement of ethics, & A preparedness to treat the innovation as a hypothesis that requires rigorous evaluation to estimate its impact on children’s lives
Much of the presentation focused on the failure of children’s services, including Children’s Fund, to rigorously evaluate innovation. The best way to evaluate the impact of an intervention on child outcomes is an experimental evaluation or randomised controlled trial or RCT -see Prevention Action for definition. RCTs are not the only form of evaluation, and they are not the best way to answer other important questions such as whether or not a design is well implemented.
The perils of not evaluating using experimental methods are explored in several stories in Prevention Action; see for example: start-finding-out-if-sure-start-children-centers-work Sure Start is expensive. The evaluation indicates few beneficial effects, and some negative. But the design means we do not know if the results are due to Sure Start being ineffective or the evaluation being misleading. Michael Rutter’s article ‘Is Sure Start an Effective Preventive Intervention?’ in Child and Adolescent Mental Health, 11 (3), , 2006 is an excellent summary of the problem.
There was much conversation about the public health approach to prevention. The basic idea was set out in terms of alcohol consumption in the US and UK, and illustrated in the following slide. The idea is that by reducing the average amount of alcohol consumed by the average drinker in the UK (to levels in the US), over an extended period of time, the tail of the distribution, that is the proportion of alcoholics, would also shift.
Universal Prevention: Alcohol Intake in the UK and US
In one of the exchanges, the practical question about how to measure outcomes was raised. There was not time for a full answer. But the following slides may help. The three slides are from one study in Birmingham. It is based on reliability -different people completing the same instrument on the same child arrive at the same conclusion- and validity -the instrument measures what it is intended to measure- of instruments applied to a representative sample of children. There is good comparison data for most of the measures listed. Dartington and other research organisations have good databases of reliable measures. The two results slides give data on what is happening to ordinary children -the mean in the distribution- and to those whose development is impaired -the tail of the distribution.
KIDSCREEN TISH (Things I Have Seen and Heard) SDQ (Strengths and Difficulties Questionnaire) PWI (Personal Well-Being Index) PLQ (Personal Lifestyles Questionnaire) PSI (Parenting Style Inventory) instruments
n = 5,858 all (7-18 yrs) Britain (11-15 yrs) SDQ mental health: behaviour
Birmingham comparison 20% 11% n = 5,858 all (7-18 yrs) Britain (11-15 yrs) SDQ mental health: behaviour
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