prevention and early intervention with children in need: definitions, principles and examples of...

Prevention and Early Intervention withChildren in Need: Definitions,Principles and Examplesof Good Practice

Michael LittleDartington SocialResearch Unit

Prevention and early intervention for children in need has

considerable appeal to policy makers and professionals operating from

health, education and social services contexts. This paper sets out

definitions intended to inform the development of ideas in this area. It

summarises principles of effective prevention and early intervention

based on an extensive review of the literature. It then sets out

examples of good practice, one from previous North American

attempts to give vulnerable children a better start in life, the other a

contemporary illustration from England which seeks to build on some

of the principles of good practice. Copyright # 1999 John Wiley &

Sons, Ltd.

The idea of prevention has much appeal to any pro-fession. Why spend so much time and effort dealingwith difficult problemsÐoften ineffectivelyÐwhen the

problem could be stopped from happening in the first place?This article is about children in need as defined by the ChildrenAct 1989 and is aimed at professionals in health, education,social services and police settings; but the opening sentimentsand observations that follow hold true in just about anyprofessional context.

Despite its generic appeal, there will be periods whenprevention is used more frequently in the vocabulary of policymakers and practitioners than others. At certain times therewill be requests for overviews of the evidence and new pre-vention initiatives will be launched. Occasionally they will becarefully evaluated and professionals will become moreattuned to prevention opportunities. Since, however, so littleis usually known about the nature of the problems being pre-vented and the volume and type of activity marshalled inresponse to them, it is difficult to decide whether modificationsto professional vocabulary offer any indication of change inprofessional behaviour.

CCC 0951±0605/99/040304±13$17.50

Copyright # 1999 John Wiley & Sons, Ltd.

CHILDREN & SOCIETY VOLUME 13 (1999) pp. 304±316

Correspondence to: Michael Little,

Dartington Social Research Unit,

Warren House, Warren Lane,

Dartington, Totnes, Devon

TQ9 6EG.

Much of this article is an argument for a clearer set of ground rules to be used in respect topreventative activity. This is certainly not the first word on the subject (much of whatfollows relies on the experience of others who have thought more deeply about the issue)nor will it be the last, but it might encourage more widespread interest in a common use ofterms, ideas and principles. A good place to start is with definitions in respect of childrenin need.

Definitions

(i) Children in need

The concept of children in need is one of the foundation stones of the Children Act 1989 inEngland and Wales (with adaptations in Scotland and Northern Ireland). It is a definitionthat has relevance to all children since all potentially have needs. It is a definition whichshould interest professionals in health, education, social services and police since itencompasses all aspects of children's lives, not just their need for protection frommaltreatment, for a safe place to live or for the other commonly specified aims of childwelfare legislation.

In legal terms, the Children Act 1989 defines as in need any child whose health ordevelopment is impaired or is at risk of impairment. This is helpful but not entirelysufficient. It acts as a guide to clinical judgement (although more work is required to helpprofessionals make consistent judgements), but has proved difficult for local or healthauthorities to apply as a threshold to an entire population.

Work at the Dartington Research Unit is currently testing different applications ofthresholds at the clinical level and for general populations. These take three tracks, the firsttwo of which are most relevant here. First, by looking at an entire community andgathering information on every resident child it has been possible to test the effect ofdifferent thresholds used to define need in the local population. It is too early to report thefindings of this work, except to say that it does seem possible to construct an empiricallybased definition of children in need built, as it were, from the ground up (Axford, Littleand Morpeth, 1999).

A second route has been to look at all referrals to health, education, social services andpolice in selected geographical areas (Little and Madge, 1998). This is a partial view of needsince it is based on those that come forward for help. It nonetheless reveals more about thepattern of need than had previously been understood. For example, one in four children inone of the selected localities was referred as being in potential need each calendar year. Itshows that the majority of referrals were to education and health services but that for thelong-term cases social services often became the provider. To this type of evidence it ispossible to add several other studies whose empirical base is referrals to social servicesdepartments (Aldgate and Tunstill, 1995; Tunnard, 1999; Aldgate, Bradley and Hawley,1999).

A third route has been to test the consistency of professionals' judgement about whether ornot a child is in need and, if he or she is, the seriousness of that need (Little and Ryan,1999). The results are at the same time both discouraging and encouraging. With very littleguidance, only about 40 per cent of professionals (even when all are members of the same

Prevention and Early Intervention with Children in Need 305

Copyright # 1999 John Wiley & Sons, Ltd. CHILDREN & SOCIETY Vol. 13, 304±316 (1999)

professional group) agree on where thresholds should be placed with respect to individualcases. After some discussion about uncertainties and initial disagreement, the proportionrises to about 80 per cent, meaning that for one in five cases it is extremely difficult to get acommon view.

This tentative empirical evidence is reported to support the proposition that the first taskintrinsic to solid progress is for professionals within local and health authorities to worktogether (and where possible involve children, families and community representatives inthe process) to agree an empirical definition of children in need. Ideally, this should taketwo routes: the first beginning with some assessment of all children in the community, thesecond encouraging professionals to discuss how they can make consistent judgementsabout the cases that are referred.

Wise local and health authorities will also use the opportunity of working together betterto define the nature and pattern of children's needs, a practical consideration that will alsocontribute to academic requirements for precision and rigour, which in turn will contributeto better practice.

(ii) Children's services

With or without the evidence, most localities will recognise that few children have needsthat can be fully met by single agency. In England and Wales, children's social needs arereferred to health, education, social and police services, and where these needs are met anintervention comprising a combination of professional contributions is likely to be applied.Much of the input comes from local government agencies with a proportionÐprobablyabout 10 per centÐbeing purchased from the voluntary and private sectors. The term`health, education, social and police services on behalf of children in need' is a little longwinded and so, for the sake of brevity and to avoid repetition, the shorter description ofchildren's services will be used from here.

In the United Kingdom and for health services in most other developed nations, it is nowcommon to grade an intervention according to its place in the development of the problembeing addressed. In England, for example, child and adolescent mental health services usethe terms tier one, tier two, tier three and tier four services (NHS HEA, 1995). The first tier isconcerned with problems in the early stage of their development, the second requires morespecialist help and the third refers to the more serious and complex cases. The fourth tierfocuses on cases who have failed to respond to activity in the three previous tiers.

Unfortunately, whatever the grading system employed, what these agencies actually do onbehalf of children has become unclear. Certain functions, usually undertaken on behalf ofthe most difficult cases, for example the provision of special education, some child andadolescent mental health services and foster care, are relatively clear. But, too oftenfunctions become blurred so that social workers, to select a case in point, often describetheir contribution during the assessment or review process as part of the intervention itself.

As true as these claims may be (there is no evidence for or against) the lack of clarity is ahandicap when trying to classify the nature of activities into various forms of preventionand intervention. It also makes evaluation problematic since it is difficult to pinpoint whathas worked, for whom, when and why.

306 Michael Little


Most of the examples of effective prevention and early intervention on behalf of children inneed rely on well-defined activity on behalf of well-defined groups of children. Someexamples are given here. They may appear alien to some readers but they are probably apre-requisite for more effective children's services.

(iii) Prevention, early intervention, treatment and social prevention

There are mountains of books setting out different classifications of professional andvoluntary activity on behalf of different categories of people (Albee and Gullotta, 1997). Inthe context of children's services, it has been common to distinguish between primary,secondary and tertiary prevention where the first stage is to stop the problem happening atall and the third is to ensure that a well established condition improves (Hardiker, Extonand Barker, 1991; Sinclair, Hearn and Pugh, 1997).

In a recently published overview of research on prevention, a slightly different formulationwas assembled reflecting some changes in thinking about prevention activity (Little andMount, 1999). It has four categories:

. Prevention to intervene with an entire population to stop potential problems fromemerging. Universal pre- and post-natal care to reduce infant mortality is an illustrationof such activity.

. Early intervention with people who show the first indications of an identified problemand who are known to be at unusually high risk of succumbing to that problem. Specialclassroom help with children who are exceptionally active in primary school would beone illustration, inoculation against childhood diseases is another.

. Treatment or intervention to focus on the particular circumstances of individuals whohave developed most of the symptoms of the identified problem. Notwithstanding theaforementioned criticisms about lack of specificity, most established children's servicesfit into this category.

. Social prevention to minimise the damage that those who have developed an identifiedcondition can do to others with whom they come in contact. Encouraging people not toleave their property unattended as a mechanism for reducing opportunities for crimeprovides an illustration of social prevention in the context of children's services.

(iv) Preventing a need not a service

One reason for eschewing the primary, secondary, tertiary formulation was its association,in the 1960s in particular, with the idea of preventing a service. This was particularly thecase in respect to social services interventions (Barclay, 1982). A typical example would bethe introduction of services intermediate between a child's home and residential care(intermediate treatment as it became known) in order to reduce the overall numbers ofchildren placed in residence (Thorpe and others, 1980).

This was a popular and in many ways successful formulation. But, the emergence of theconcept of a continuum of services to meet the identified needs of children, a perspectiveimplicit in the Children Act 1989, required a different approach. It is now recognised thatover time complex needs may require several services from several agencies. It does nothelp, therefore, to place health services in opposition to social services or day care againstresidential care since all may be a necessary part of a child's recovery.



In the context of children's services, therefore, a modern definition of prevention emphasisesthe notions of preventing a need from arising and highlighting those services most likely toachieve the best results.

Principles of effective prevention and early interventionwith children in need

So far, this article has been concerned with questions of definition. Although it has notdefined children in need, services to meet those needs or the special nature of preventativeactivity, hopefully it has offered some useful insights that highlight the value of workingtowards a common language on these issues. As might be expected from an empiricalresearcher, much of the language used has either built upon what has gone before or invitesmore evidence (or both) about children. It has also often been implicit that the production ofuseful data should not be the sole preserve of researchers. Indeed, there is much to be said forencouraging communities to build and learn from their own evidence base.

For many policy makers and practitioners these suggestions will appear inconvenient. Itmay seem much more expedient to work from a set of principles setting out what is knownabout effective prevention and early intervention. Dartington's recently published reviewof evidence on the subject ends, reluctantly, with such a set of principles. The hesitationreflected doubts about whether good practice would emerge from the application of theprinciples; more likely that the principles will be reaffirmed by good practice, especially ifit is evidence based.

Nonetheless, the principles are set out again here, with greater brevity. A summary allowsspace to discuss selected ones in more depth. This approach enables us to provide twoexamples of good practice, one historical, the other contemporary. The first two principlesare:

1. Prevention and early intervention tend to be more effective when they are a response toclear evidence on the needs of children in any location. It is better to start from empiricalevidence about the nature of a problem than from professionals' or managers' percep-tions. (Such evidence can be rapidly assembled and need not rely only on publishedresearch studies.)

2. Prevention and early intervention are more effective when they are designed in responseto clear evidence about the likely causes of children's problems. Most authoritativeevidence expresses these potential causal links as `chains of effects' in children's lives.

Discussion around the second principle

The causes of the various problems experienced by children in need are still a matter ofspeculation. There is plenty of evidence of proven associations between one variable andanother, but this is not the same as identifying cause (Wadsworth, 1991; Rutter, 1979).Hence, it is known that children with needs for warm and supportive relationships athome are more likely to be growing up in poverty despite the fact that most poor parentsprovide a close and loving environment for their children (Department of Health, 1995).There is some possible association between a child's genotype and his or her likelihood of

308 Michael Little


later conduct disorder (Rutter, Giller and Hagell, 1998). But, as yet none of these resultsadd up to a clear indication of what causes different types of childhood difficulty.

This difficulty should not lead us to abandon efforts to connect interventions (early or late)and potential explanations of cause. The nearest approximation to cause in the children'sservices field are the hypotheses about chains of effects forwarded by researchers mainlyworking in the field of psycho-social development (Rutter and Smith, 1995; Sampson andLaub, 1993). Here, the concern is not so much how what happens today influences whatoccurs tomorrow or even how a single event can lead to a subsequent occurrence. Chains ofeffects suggest the interplay of several risk factors interacting over time, sometimes beingmediated by protective factors operating in a child's life.

The longitudinal studies following birth cohorts in the 1940s, '50s and '60s are the bestsource of information on potential chains of effects (even if the studies do not always usethe chain metaphor) (Essen and Wedge, 1978; Kolvin and others, 1990; West andFarrington, 1973, Farrington, 1990 and 1995). For example, Wadsworth found that poordiet and unsatisfactory environment predisposes children to infection and the inhibition ofgrowth or biochemical development. In the longer term, poor child health correlates withpoor adult health, particularly respiratory and cardiovascular illness.

These data give health, education, police and social services the best clues about where toplace their scare resources. This way of thinking also provides an opportunity for children'sservices to plan interventions that may be evaluated and so contribute to the existing stockof knowledge about chains of effects for children in need. There is greater scope for policymakers, managers and practitioners to learn from research but, under the right conditions,so too is there an opportunity for researchers to learn from careful evaluations undertakenby professionals in a practice setting. One of the examples of potentially good preventionand early intervention practice set out below illustrates the possible overlap.

Principles continued

3. Since chains of effects intersect all areas of children's lives, prevention and earlyintervention require the cooperation of health, education, social and police services aswell as voluntary agencies.

4. Better diagnosis is a prerequisite of improved understanding of the balance betweenprevention and intervention early and late in children's services. The goal should beconsistency between one professional and another about the nature of children'sneeds, their seriousness, the likely prognosis and conclusions about what works.

5. Since children's social and psychological problems are frequently a manifestation ofdifficulty in several areas of life, an accurate diagnosis requires information about allaspects of the child's situation from birth to the point of referral.

6. Prevention should complement early intervention, treatment and social prevention asthey are defined earlier. Professionals should regard these activities as complementaryand not in competition.

Discussion about the sixth principle

Because prevention has such an obvious appeal to professionals, there has been a tendencyto place it against other activity design to tackle the problem in hand. Stop the problem



occurring in the first place and there will be neither need for intervention, early or late, nora requirement for social prevention. On the back of such discussions are built argumentsabout cost. Spending a little more earlier on in the development of an identified problemmay save much more money later on. Unfortunately, the logic in each case is not supportedby empirical evidence.

John Snow was a pioneer in medical prevention. Without being able to explain the causalchains, he hypothesised that drinking water was a probable carrier of cholera, which, in themid-1800s was a major cause of death in London and other major cities. His theory waswidely derided and it is said that he removed the handle from a water pump thought to be asource for the disease and, in so doing, prevented several cholera deaths (Porter, 1997). Hiswork led eventually to the treatment of water, a major and successful prevention strategythat has greatly reduced the incidence of the disease, in the economically developed worldat least.

But people still die of cholera today. The disease has not been eradicated and nor has anyother (except smallpox) been stopped as a result of a prevention strategy. Several othermechanisms help keep the disease to a minimum. Those in or travelling to infected areas aregiven inoculations so they build up resistance to the disease, a successful early interventionstrategy. Those who develop the condition are treated by rehydration therapy, anintervention that has greatly reduced the mortality rate. Those who treat or live withcholera sufferers use social prevention strategies which means they are unlikely to contractthe disease.

Hence the appeal to look to combinations of prevention, early intervention, treatment andsocial prevention when trying to change the pattern of children's problems. Note that it isthe pattern that changes not necessarily the volume. To use the cholera comparison again,the combined forces of prevention and other interventions have reduced the incidence ofthat disease (cholera) but have not eradicated disease as a whole. For this reason, it isprobably folly to imagine that more prevention will reduce overall expenditure on children'sservices. In his review of the cost-effectiveness of various prevention programmes, Welsh(1999) shows the results to be at best mixed with some experiments increasing notdecreasing the burden on the public purse. These findings are not arguments againstprevention but they do offer counsel on its effective use and realistic expectations aboutoutcomes.

Principles continued

7. The object of the exercise is to prevent the development of problems. It is counter-productive to think in terms of preventing a service. Services should be providedonly when there is evidence that they benefit some children at some point in theirdevelopment.

8. Professionals in agencies should work to a common definition of prevention and agreeon how this activity differs from other forms of intervention, early and late.

9. Effective early intervention and prevention involve sharing knowledge and with itthe burden of developing new knowledge separately or in combinations in differentlocations. No location will develop all the answers alone and all will have somecontribution to make.

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10. Early intervention need not mean early in a child's life. `Early' refers to early in thedevelopment of any social or psychological problem and so can apply as accurately toa 16-year old exhibiting the first signs of mental health problems as to a three-year oldwhose difficulties in school may prefigure later behavioural problems.

11. Since the majority of support for children in need comes from within the state infra-structure of health, education and social services, effective prevention and earlyintervention will be delivered within or with the expressed cooperation of theseagencies.

12. There is evidence for and against universal and targeted modes of prevention andearly intervention activity (Rose, 1992). Targeted prevention is a better strategy since itcan be used to assemble better knowledge about the development of children's needs.

13. A proportion of all expenditure of services for children in need should be devoted toevaluating the effectiveness of that service. The principle applies as much to inter-ventions as it does to prevention and as much to the activity of local and healthauthorities as it does to the voluntary and private sector, and as much to existingresponses as the innovative.

14. Many ideas for better prevention and early intervention are unproven. New initiativesshould incorporate evaluation designed to explain the nature of the problems beingaddressed as well as the effectiveness of individual responses. A consistent andsystematic approach to new initiatives would ensure effective sharing of resultsnationally and internationally.

15. The effects of good prevention and early intervention activity may be delayed forseveral years, for example, when effective parenting support for pre-school childrenreduces later antisocial behaviour. Evaluations have to allow for the measurement ofsuch delayed effects.

16. Since nearly all children in need live with their families and nearly all separatedchildren eventually return home, effective prevention and early intervention must takeaccount of the ordinary features of family life and incorporate their strengths.

17. Much of the expertise concerning the solution of children's problems rests withchildren and families themselves. Effective prevention and early intervention beginwith professionals asking how children and families cope with specific problems.

18. Effective prevention and early intervention strategies may depend on a sophisticatedunderstanding of causal mechanisms, but they are likely to take the form of simplepractical help for the practical problems experienced by children and their families.

19. There are considerable strengths in current arrangements for children in need as wellas many identified weaknesses. Effective prevention and early intervention build uponagencies' known strengths and set clear targets to overcome identified weaknesses.Good prevention work is not a matter of starting from scratch.

20. Effective inter-agency work does not necessarily require or imply that work is donefrom the same geographical or bureaucratic location. The ability to work across con-ventional boundaries is a particularly important component of effective preventionand early intervention activity.

Examples of good practice

(1) High Scope

Probably the most referenced prevention and early intervention programme is the HighScope Perry pre-school established in Ypsilanti, a university town near Detroit, North



America in 1962. It sought to evaluate the benefits of good pre-school programmes on poorworking class children. Its claims about being highly cost-effective in the long-term haveelicited many counter claims and doubts about the methodology. That said the design isrigorous although the numbers involved were small.

High Scope aimed to help poor children make a better start in the transition from home tocommunity through pre-school programmes. The initiative emerged from Headstart, across US initiative that by the autumn of 1965 had served half a million children in13 000 centres supported by 41 000 teachers and a third of a million other helpers. Thelong-term goal of High Scope became the self-sufficiency of the children as adults.

Given its initial size, High Scope is incredibly well known. It was offered to 58 childrenaged three and four years. They were at high risk of psycho-social difficulty in adulthoodand came from areas of low socio-economic well-being where children had traditionallyperformed badly in school. Two fifths came from families where no adult was employed;nearly half were from lone parent households; and, even by 1960's standards, exceptionallylow proportions of the parents (11 per cent of the fathers and 21 per cent of the mothers)had finished their own schooling.

Teachers were employed to engage the children in a high quality, active learning pro-gramme in the two years prior to mainstream school. The half-day sessions were offeredduring school term times, every working day. Teachers worked with the childrenindividually as well as in groups. The goal was to enhance cognitive and social skills. Inaddition, the teacher visited the child's home once a week and encouraged parents to takean active role in their child's education.

High Scope was rigorously evaluated (Schweinhart and Weikart, 1980; Schweinhart andothers, 1993). The 58 children on the programme were matched with 65 deprived childrenwho did not receive any special intervention. All 123 children, 72 boys and 51 girls wereassessed every year between the ages of three and 11 years and then again at 15, 19 and27 years. The results have been published in several papers and are best summarised inWeikhart and Schweinhart (1997). Initially, the High Scope children did not fare any better.The encouraging results came later in later follow-ups and extended to nearly alldimensions of the children's lives.

At 15 years, the High Scope children were reporting lower levels of involvement in crimethan their matched cases and at 19 and 27 years they had experienced significantly fewerarrests. Most notably, the proportion of chronic offenders (defined as those arrested five ormore times) was seven per cent for the High Scope graduates compared with 35 per cent forthe controls. This outcome was no doubt encouraged by the higher income, home ownershiprates and second car ownership of the High Scope children, which in turn probably boresome relationship to their higher rates of school completion. The economic cost-benefitanalysis of the Ypsilanti scheme estimates that it saved seven dollars for every dollar spenton each individual involved, an extraordinarily high return for a scheme of its type.

(2) A contemporary and speculative example

Earlier in this article, research to help local and health authorities identify patterns of needin the children referred to help in a selected geographical location was considered

312 Michael Little


(Little and Madge, 1998). The methods used in this study have allowed health, education,social services and police to work together to design new services for specified groups ofchildren in need. Several service designs have emerged in 12 international sites experi-menting with this approach: one is offered here as an illustration.

In one mainly rural location with a total population of 100 000, 700 children each yearreferred to children's services because of their relatively minor social, emotional or learningneeds have been targeted. These children had needs described as an acute form ofadolescent unhappiness, which, left unattended, were thought by professionals as likely tobe manifest in school exclusion, youth crime and strained family and social relationships.

The method used for service design in this context requires professionals jointly to examinequantitative and qualitative evidence on the needs of children in that category. Theevidence comes from children referred for help in the previous calendar year. It extends toall aspects of children's lives. Professionals are next asked to specify the outcomes theythink are achievable within a specified time period. They are asked to consult the relevantresearch evidence along the way. Having agreed potential outcomes, professionals areasked to set out services likely to achieve those outcomes. Next they turn to thresholds,specifying both the level of impairment to health and development required for a child toqualify for the specified service and other characteristics that can be used by professionalsto select children for the intervention. Each new service has an evaluation built in, usually arandomised control trial or quasi-experimental design.

For the children with low-level emotional health problems just described, the desiredoutcomes were pretty clear cut. Professionals sought to help the child remain at home withrelatives for at least a 12-month period. There was also a goal for the parent and child to behappy (if relationships were judged to be satisfactory at referral) or happier (if they weretroubled at referral) six months after the intervention began. The programme intended that95 per cent of referrals would not be convicted of a criminal offence within six months andthat there would be some measured improvement in self-esteem in 75 per cent of cases.Fundamental to these outcomes, an objective was outlined to return all children in thisgroup to school (if they were away) or to maintain them in full-time education with at least90 per cent attendance.

To achieve these goals, an enhanced preventative programme is being established in thelargest town in the area experimenting with the methodology. This encompasses an adviceand information service covering such things as leisure and contraception and is thought ofas a kind of Citizen's Advice Bureau for children. Those children meeting the thresholdsfor inclusion in the group and picked up by health, education, social or police services arethen referred on to a designated youth coordinator funded by all the agencies. Thecoordinator ensures that all children get one of two services: (a) youth education supportwhich involves mentoring by a volunteer working with the young person outside of and,where appropriate, inside school; (b) youth health support comprising specialist advicefrom an expert with `street credibility'. Young people accepted onto the programme areoffered up to 35 hours of education or health support over a three-month period as agreedwith the coordinator.

Cases referred to the coordinator are being randomly assigned to the new service or toexisting provision. Both groups are being followed up at six months with comparisons



concentrating on stability of living situations, self-esteem, participation in education,family and social relationships and criminality. It is too early to say whether the inter-vention is having its desired effects.

Conclusions

Interest in prevention and early intervention is, like much else in the children's servicesworld, subject to change. But each time it comes into fashion, the focus is different and newinsights and understandings emerge. In the current cycle, it is the potential coincidencebetween new resources for prevention activity and the concern to use and build anevidence base for children's services that excites.

There are many potential difficulties to overcome if this opportunity is to be seized. Theknowledge base in children's services is extremely weak. Most agencies do not understandthe pattern of need and many are struggling to quantify the volume of children andfamilies being served and the way in which their business overlaps with that of otheragencies. The amount being invested in understanding and producing evidence is pitiful;the contribution of all social services departments in England and Wales adds up to lessthan one pound for every thousand spent (compared with one in a hundred for theNational Health Service dealing with medical matters). Local health authorities are better,but not much better. When the British government announced its SureStart programme toemulate the 1960s Headstart, it devoted less than one quarter of one per cent to researchingits effects (Department for Education and Employment, 1999).

The bulk of the evaluation should be taking place within the infrastructure of children'sservices and should focus on the benefits, side effects and drawbacks of existingapproaches. The low interest expressed in evidence can lead the uninformed observer tobelieve that social and health services in particular, are less concerned with preventionthan are the smaller voluntary organisations operating outside of the central bureaucracy.(This perception is not helped by the fact that small voluntary organisations seem moreanxious to evaluate outcomes.) From what little is known this is a misperception; the bulkof a social worker's, health visitor's and possibly a general practitioner or police person'sday is likely spent on some form of activity engaging early on in the development ofchildhood difficulties.

As important as building a reliable knowledge base are some realistic expectations aboutwhat better prevention and early intervention can achieve for young people. Prevention isno more an alternative to early intervention than early intervention is to treatment or socialprevention. It is the combination of these activities that can make a difference to children'slives. But, even then, the ultimate balance between the four parts of the professionalcontribution will never eradicate a need. The best that can be hoped for is to change thepattern of childhood disturbance in a community and that along the way, something can belearned about how that change was achieved. Those waiting for prevention to bring an endto or even significantly reduce levels of delinquency, child abuse or mental healthproblems will require a patience that endures beyond their lifetime.

Much of this speaks to a desire for some common language to help ease communicationbetween those who seek to support children in need; from the top of each agency to the

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bottom, from one agency to another and even between countries. Such a task is immensebut agreeing what is meant by prevention and how this differs from early intervention andother activity on behalf of vulnerable children could make a valuable start. If nothing else isachievable in the context of the current preoccupation with all things preventative, thismuch should be possible.

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Contributor's details

Michael Little is Co-director, Dartington Social Research Unit, and Visiting Fellow at the Chapin HallCenter for Children at the University of Chicago. He is a career researcher on children in need.

316 Michael Little


prevention and early intervention with children in need: definitions, principles and examples of...

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