1. www.learningbenefits.net Leon Feinstein 18-July-2006 Targeted and universal intervention

2. www.learningbenefits.net Five questions How well can we identify those children at risk of adult social exclusion? Which measures are most predictive? What difference does it make? What are the implications for the delivery of services? What are the implications for the targeting of interventions?

3. www.learningbenefits.net E.g. Relationship of G1 maternal interest at G2 age 7 and G2- G3 parenting at G2 age 33 Home_CogHome_Em Low interest00 Medium interest4.7 ***2.5 *** High interest7.2 ***2.7 *** Over-concern8.7 ***1.0 N38733697

4. www.learningbenefits.net Relative cognitive shifts, 7 -11, by SES, 1958 Cohort Source: Feinstein, L. Schools and Educational Attainment, Oxford Review of Economic Policy, (in press)

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6. Skills and capabilities; Probability of being in workless household with children at age 30 Source: Feinstein, L. and Bynner, J. (Dec 2003), The benefits of assets in childhood as protection against adult social exclusion: the relative effects of financial, human, social and psychological assets, Note to HM Treasury.

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8. Conceptual model for family influences on child development

9. www.learningbenefits.net Some cost-benefit notation C(T+) = The social cost of the outcome (T=truth) P(T+) = The unconditional probability of the outcome P(D+)= The level of targeting of the intervention C(D+)= The cost of the intervention f= the effectiveness of the intervention; 0 f 1.

10. www.learningbenefits.net True and false positives Truth PositiveNegative Decision (Predicted outcome) PositiveTrue positive A False positive B NegativeFalse negative C True negative D P(TP) = P(D+ | T+) = A / (A+C) P(FP) = P(D+ | T-) = B / (B+D)

11. www.learningbenefits.net Costs and benefits C(T-, D+) = The cost of a positive decision and hence intervention for those who would not experience the outcome (deadweight +stigmatisation costs) C(T+, D-) = The cost of a negative decision and hence failure to intervene for those who would experience the outcome B(T+, D+) = The net benefit of a positive decision and intervention for those who would experience the outcome (net of intervention and stigmatisation costs) B(T-, D-) = The net benefit of a negative decision and absence of intervention for those who would not experience the outcome.

12. www.learningbenefits.net B(T+, D+) = P(D+, T+) * f * C(T+) – P(D+, T+) * C(D+) = P(TP) * P(T+) {f * C(T+) –C(D+) }

13. www.learningbenefits.net C(T-, D+) = P(D-, T+) * C(D+) = P(FP) * P(T-) * C(D+) Hence cost effectiveness requires: P(TP) > P(T-) * C(D+) P(FP)P(T+) { f * C(T+) –C(D+) }

14. www.learningbenefits.net ROC Curves: Allowing the allocation threshold to vary

15. www.learningbenefits.net Optimal point on the ROC curve S* = P(T-) * B(T-, D-) + C(T-, D+) P(T+) B(T+, D+) + C(T+, D-)

16. www.learningbenefits.net 2. Estimating P(TP) and P(FP)

17. www.learningbenefits.net Predicting teenage parenthood, by age 1958 Cohort1970 Cohort P(TP)P(FP)P(TP)P(FP) Birth22.05.723.84.0 22 months26.83.9 42 months29.23.7 5/7 years28.54.229.23.8 10/11 years30.74.360.01.4 16 years45.23.632.43.1

18. www.learningbenefits.net Predicting adult depression, by age 1958 Cohort1970 Cohort P(TP)P(FP)P(TP)P(FP) Birth34.217.332.317.4 5/7 years38.315.834.417.1 10/11 years34.616.846.711.0 16 years45.812.434.516.7

19. www.learningbenefits.net Predicting teenage parenthood, by domain 1958 Cohort1970 Cohort P(TP)P(FP)P(TP)P(FP) Distal family background31.12.152.61.3 Proximal family process21.32.119.64.2 Neighbourhood16.05.411.23.0 School25.62.723.84.3 Child cognitive achievement25.52.420.94.2 Behavioural and affective34.02.035.52.8 Health and growth19.02.815.94.4

20. www.learningbenefits.net Predicting adult depression, by domain 1958 Cohort1970 Cohort P(TP)P(FP)P(TP)P(FP) Distal family background35.715.840.114.6 Proximal family process35.015.532.517.1 Neighbourhood29.919.36.02.8 School36.416.533.317.2 Child cognitive achievement32.916.532.117.5 Behavioural and affective37.716.534.315.9 Health and growth31.818.130.017.0

21. www.learningbenefits.net Predicting other outcomes from age 10 measures, 1970 Cohort P(TP)P(FP) Workless household with children50.01.3 Mental health problem45.316.3 Serious addiction to drugs or alcohol52.21.1 Long periods of NEET (16-30)51.62.5 Long periods of NEET (16-18)26.52.9 On benefits at 3041.63.6 Multiple offending51.61.3

22. www.learningbenefits.net Predicting other outcomes, P(TP), 1970 DistalBehav. Workless household with children44.926.3 Mental health problem42.037.5 Serious addiction to drugs or alcohol42.529.4 Long periods of NEET (16-30)43.039.3 Long periods of NEET (16-18)40.624.8 On benefits at 3033.929.2 Multiple offending53.539.6

23. www.learningbenefits.net 3. Preliminary discussion Targeting depends on identification Identification capabilities are very strong So targeted intervention is possible, but: Ethical issues Stigmatisation Need effective and appropriate intervention Facilitated community engagement crucial People move in and out of risk Progressive universalism is essential Role of schools and GPs?