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Effective Interventions for Children in Need My latest book examines the impact of effective interventions at reducing impairments to children's health and impairment, and their implications for policy and practice. The abstract summarises the book below. To purchase a copy of the book, please visit this link. Abstract: This book sets out the current state of knowledge about what works in reducing impairments to children’s health and development. Little and Maughan’s book applies a high standard of proof and reproduces only the work of the leading intervention scientists from around the world. After discussing the real world challenges to more effective children’s services, the book goes on to cover policy and practice proven to change the lives of all children, and extends also to effective programmes targeted at children with specific disorders. Examples include changes in household income, early years support, moving families to less disadvantaged communities, improving parenting and using schools to better mental health. The benefits of evidence-based programmes are specified, as are the costs to society of not intervening. The evidence is used to make recommendations about getting effective policy and practice into routine use, and includes illustrations of successful applications of these ideas. ********** Recipe for Time August 22, 2010 I visited Prague for the first time in 2010. I stayed at the home of a translator and antique dealer, Eva Veselá. She was interested in how people used their time, and we got talking about my ‘recipe for time’. Here is what I wrote to her in response to her request. (Eva’s apartment in Prague is excellent. If you are interested in visiting go to: http://www.eclectic.cz/) Perhaps the first thing to say is that recipes are never exactly the same. Some people prefer an extra egg in their omelette. Some people choose cheese instead of ham for the filling. Some insist on cooking with olive oil, for others it is butter. But, however they are prepared, an omelette is an omelette, even when it is cooked by the worst English chef. Over time we may vary our recipe for our favourite dishes. We taste something somebody else has prepared and we make adaptations. With these caveats in mind, here is how I think about my recipe for time. The ingredients reflect the reasons why I need time. I do lots of things. I manage a small organisation. I have to raise a lot of money to allow that organisation to function. I have to deal with customers, and advertise what we do. Since our work is international that means a lot of travel. And all of this must fit with a full social life, and making time for the things that are important to me, reading, museums, Spain and spanish, family and friends, listening to the radio, keeping bees and so on. I could have made a long list in the previous paragraph. But I don't need time for the things in the list. What I need time for are the things that make work and life easy and pleasurable. I need to think, to write and to be myself. After that everything else is easy. At the core of what I do are ideas. Sometimes we use a technical term, concept. But a concept is just an idea. I need time to think about ideas, to form them, nurture them and express them, simply. The better thought out the idea, the more useful it will be. The most elegant ideas make my work easy and fun. But I need time to develop that idea. A lot of time. Once I have an idea, I have to write about it. I can give talks of course. Or I can just share it with people on a one by one basis. But writing the idea down is a good way of finding out if it is a good idea. Plus, a good idea well expressed can be used as the basis of all kinds of communication and other actions. It takes time to translate an idea into words onto a page and into a common understanding of that idea. A lot of time. Finally I need time to be myself. If I am happy and being 'me' then I can think and write better. If I am miserable or being 'not me' -a manager, or a boss or an important speaker, or the person who must raise the money otherwise staff will not be able to pay their mortgage- then I cannot think straight. So I need time to think, write and be myself. And I have a recipe for that. I don't always follow the recipe, and as I said before, the recipe varies from time to time. But if everything is perfect, this is what I do. The recipe Writing and thinking needs concentrated periods of time do nothing else. No distractions. I think of it as a sort of meditation. Just me and the blank page. If I am working on an idea, it might me just me. Just me and the inside of my head. Nada mas. In the best recipe, this time is a single block, of say three hours. Not longer than three hours, and ideally not shorter. And it will be devoted to one thing. To one idea. Or to one paper. The best taste comes from being able to do this day after day. If I could do this every day, I would be very clever and very happy. But usually I have to grab a day here, and a day there. Each person will have a time of the day when they can use their three hour block to the best effect. People say of themselves 'oh, I am a morning person' or ''I am at my best in the evening when the kids have gone to bed'. Speaking for myself, I am at my best cooking meals in the evening; I am at my best reading novels when I am traveling; I am most social late at night. Am I at my best thinking or writing for longish concentrated periods of time early in the morning? Not necessarily so, but that is the time of day when I can endure it best. Some people say they look forward to writing. But I don't believe them. Writing is a job of work. I no more look forward to it than I would look forward to a job as a bricklayer, or as a farm labourer. But like the bricklayer I get a lot of pleasure from the fruits of my labour. The bricklayer can look with satisfaction at the house he has helped to build. I take heart from the books, articles and blogs to which I have made a contribution. But I do not look forward to the writing. But I figure if I get started by six I can be done by nine. I loathe getting out of bed at five, but if it means I have erected half a wall or tilled a field by eight thirty then I will be a happy boy. So far so good. But we have yet to get to the vital ingredient. It is that bit of the cake that makes all the difference but that eludes the person eating the cake. 'What is that?' they ask, as they marvel at the taste. Is it a touch of vanilla? Maybe a teaspoon of rose water? In my cake, the secret ingredient is essence of resisting impulse. Well its hardly a secret really. Philip Roth has been telling the world about impulse for some time. In Exit Ghost one of his regular protagonists Nathan Zuckerman has retreated from New York to rural Massachusetts. He does not possess a television. He has neither computer nor mobile phone. He meets people infrequently, relying on a housekeeper and gardener who see to his needs and respect his demand for solitude. All Nathan has are his mind, his ideas, his books and a blank piece of paper, which he slowly and methodically fills, day after day after day. Exit Ghost takes Zuckerman to New York where he is bombarded by impulse. For sex. For putting the world to rights. For meeting the needs of other people. For nostalgia. For gossip. For all the things that fill an ordinary day in the life of an ordinary person. And Zuckerman cannot resist. And he cannot form an idea. And the page remains blank. So the essence of resisting impulse is probably the most important part of my recipe for time. And there is so much to resist. The alarm goes off at 5.30am. Just another 10 minutes. Who would deny me that? The sun is coming up, wouldn't it be nicer to walk to work? I am writing on the computer, so I will just check the news on the internet. Or worse, did anybody send me an email last night? (Of course they did, somebody always does). Another cup of tea? Never mind the four or five I downed to start the day, how comforting to make another. Making time means making a space for just me and my mind, or me, my mind and a notebook, or me and the blank sheet of paper. And being able to say 'no' to anything else. The Japanese novelist Haruki Murakami talks about this in terms of focus. He says he concentrates all his limited talent on the task in hand for three or four hours a day to the point where he can feel the effort course through his body. He says none of us want to get up and do things like write. But he tells himself that he is not alone. And that he will not join the crowd by giving in. That helps me a lot. I am not by myself doing what I do. But I am not like everyone else. Well said Haruki! Of course an idea cake or a written cake takes a lot of baking. It might be a week of mornings or a month of mornings or occasionally a year of mornings before something edible comes out of the oven. So I put a lot of store in rhythm. There is going to be a lot of mixing, so try and find that place where one can forget one is mixing so that time ebbs happily away as the ingredients magically combine. Making time go fast but getting lots done is not as easy as it seems. A lot depends on being comfortable with repetition. Its like running. One foot in front of the other. One metre after another. The second kilometre follows the first. The third after the second. The fortieth after the thirty-ninth. Wait, what happened to the twenty-second? It just disappeared but I did it and I covered the distance. Repeating oneself over and over takes a lot of preparation and training. Murakami talks about making constant repetition of successful process a part of your personality, When time and I are friends, for at least part of the day, I am like an automaton. I concentrate on just a few things, and I do them over and over and over again. Now and then I can bake this time cake for me alone. I wrote a blog about training for a half marathon. Some people liked it, some people hated it, probably most people didn't care one way or the other. It didn't really matter to me. It was just for me. If other people wanted to read it then fine, but as far as I was concerned it was nothing more than leaving one's diary open on the kitchen table. It was inevitable that some people would read it. I can do this but at other times I am happy preoccupying myself with an idea I know I will never share with another living soul. But most of the time its not like that. Most of the time I am doing something for someone. Ultimately more or less everything I do is intended to improve the lives of children. But to achieve that end I have to get people to think and behave differently. So in these little blocks of time I try and keep in mind the people who will use what I am trying to produce. When I started work, I had a boss who made me read out loud to him what I had written. 'Who in their right mind would be interested in mindless drivel like that?' he would say. And he was right. He was getting me to think about the audience. And doing that means I make the most of the limited time available to me. The famous economist Steve Aos, who writes for politicians in the Washington State legislature, says that when he is writing he places on top of his computer a picture of an influential senator who is likely to read one of his reports. And he says he uses the verbs and adjectives and sentence construction that the senator understands. Aos spends his time doing something for someone who will do something for someone else. It's a good feeling being a link in such a chain. Murakami says that when he ran a jazz club nine out of ten people either didn't come in or came and left quickly. He didn't worry about them. He put all of his effort into making the club right for the one in ten repeat customers. He tried to make it a night to remember for each and every one of them. And when I do the same I find the time goes quickly and the work gets done. One never knows how well one is doing until right at the end and the cake stand is empty and there are a group of satisfied customers happy and full. But an indication that things are going well is that time is going fast and the work is getting done. And if its taking an age and there is nothing much to show? Well there are plenty of days like that as well. I take a lot of time thinking about where I will work or write. I don't know if this is worthwhile effort but I do it all the same. Five hours in a first class carriage from Paris to Hendaye is a good environment to think, and occasionally to write. The countryside whizzes by and I go into a reverie and its all I need to think about one thing and one thing only. At other times I find myself in a dreary hotel room with a simple desk and I know its just right for what I need to do. At Dartington I write standing up at a draughtsman's table. Over a desk I can slump, rest, fall asleep even. But standing up I am doing a job of work. I am the bricklayer building a house. The farm labourer ploughing the fields. In a way all of this is just dressing up, trying to divert attention from the fact that what I am doing is dead boring and hard work and sometimes soul destroying. If I thought about it for long enough I would never have another thought and never write another word. So I think about the rewards. Its sufficient at times to contemplate the finishing line, that feeling of having run ten, twenty, thirty or more kilometres. Sometimes I am looking to get over the next hill or just round the next corner to a point where I can find another reason not to stop. Generally speaking I have to keep looking forward. It doesn't help much to think back to previous successes. It's hard to imagine that I have written any books or come up with any useful ideas. Somebody else must have done that and I just happened to be around. But what is coming next, that is just me, and what a joy it will be to get to the other end. If it all goes according to plan my day will be more or less done by nine or ten in the morning. Anybody can do what I do for the rest of the day. But in my tiny universe not many people have the talent to do what I aim to do in those first hours of the day. So if I resist the impulse and do what I set out to do I can face the rest of the day knowing that even if I fiddle around I will go home having done something useful. I have burned a lot of omelettes I could go on in this vein for many pages. But I would just be saying more of the same. Give priority to the skill where there is some indication that your talents can reap disproportionate rewards. Allocate to that task, for as many days as you can manage, a short concentrated period of time, say three hours. Resist all impulse and focus on just one thing, an idea or a piece of writing. Prepare for that time and try and get into a rhythm so that repetition rules. Get into what Mihaly Csikszenmihalyi calls the 'flow'. Recognise the space where all of this can happen. And think about the rewards, big and small, long-term and short-term, along the way and beyond the finish line. Do this a dozen or so times and a good idea might sprout. Do it for three or four months and there might be a substantial piece of work to show. What I am trying to do here is to manipulate time. I am making it longer by allocating short chunks to a single focus. And I am making it shorter by shutting everything else out and getting into a flow so that time moves pleasurably quickly. Is that it? Probably. It is probably as easy as cooking a good omelette. All I know is that I have burnt many more omelettes than I have prepared good ones. Everything I have said is about what happens when a delicious cheese and ham omelet, as good as the best French chef can routinely deliver, slips effortlessly onto the plate. What I haven't said, because I don't know what to say, is about what happens when the eggs don't make it out of the carton, or when I forgot to buy the cheese, or when I lost sight of why I was preparing the dish, or when I did everything right but it just didn't work. I ought to be thinking and writing about that, but I don't seem to have the time.
27th of November 2009 A trip to a Bristol primary school that has become a beacon of enthusiasm for the UK Social and Emotional Aspects of Learning program overturns some of my prejudices. A balance has yet to be struck between the art of framing a national child development policy to apply at scale, and the science of developing an intervention that can be shown to improve children’s lives. There are many examples of the former but none that has made a clear impact on child well-being; many of the latter, too, but none that has been taken successfully to scale. An example of the inherent difficulty is the UK government programme known as SEAL (Social and Emotional Aspects of Learning). It has been made available to every primary school in England, and is now being tried in secondary schools. On the other side of this particular equation are the 22 school curricula that are known to improve children’s social and emotional development (and also, as Joe Durlak’s recent systematic review indicates, their educational performance). A starker reading of the basic scenario, which I confess I’ve been inclined to support in the past, points to the failings of a UK government that ignores the evidence and forces everybody to behave in a way that is unlikely to have any impact on children’s lives – not that we’ll ever know, because there’s no funding for rigorous evaluation. So it was with some misgivings on Friday that I went back to school with a colleague and one of the originators of SEAL to re-examine the story by visiting a small primary in Bristol in the west of England. It turns out to be not so simple. The rationale for preparing SEAL as an amalgam of proven models instead of implementing one or more off the shelf probably made sense a few years ago when less was known about appropriate adaptation and service design. The champions of SEAL felt that UK teachers would not respond to the detailed lesson plans used by their US counterparts for whom the proven models were designed. On closer inspection, the malign hand of government turns out to have been a wriggling mass of fingers, thumbs and toes of politicians, civil servants, teachers unions, expert advisers and more. Hearing about what really happened, one realises that it’s something of a miracle that anything at all was delivered, never mind that it should have found its way into more or less every school. The best example of the final product was impressive: lessons for every stage of a child’s development; lots of evidence of the programme around the school; enthusiastic teachers well supported with manuals, training and coaching; strong leadership, and an interest in monitoring impact. In this school at least, SEAL seemed just as likely to achieve the impact being sought by proven models such as PATHS (which is being introduced with equivalent care in Birmingham). SEAL has the advantage of being English, and having the support of government as well as the approval of many teachers and heads. But we don’t know if it works. Birmingham, which is pitching well supported PATHS against routinely provided SEAL, may provide the beginnings of an answer. But there are a host of other enquiries and discoveries to be made before we know how to improve the lives of children not in 100 or even 1,000 schools, but in all 25,000 or so English schools. Of course, all this presupposes that public opinion supports the efforts of schools to improve children’s social and emotional development. On my travels, I also learned about politicians who feel strongly that schools should be about schooling, by which they all too often mean the ‘three Rs,’ when just a few hours in an ordinary primary school would surely convince them that something has to be done to afford students the chance to learn. One boy, struggling to understand how respect inside the classroom should mirror expectations outside it admitted without embarrassment: ‘We don’t have rules at home. If you do something wrong, you get a slap’ University of Nottingham I was invited to give a presentation at the last of a series of six ESRC-sponsored seminars gathering “interdisciplinary perspectives on emotional well-being and social justice in education policy and practice” It was intended to reckon with the implications for education policy and practice – could or should education attempt to develop emotional well-being as a response to deep-seated social problems? I found the meeting frustrating. It reminded me of a conference on violence prevention I attended years ago which ended in a fist fight between two of the presenters. The fundamental question raised by the seminar is an important one, nevertheless: in our efforts to improve the lives of children, are we visiting some kind of abuse on them? Several of the seminar participants had a very clear view about what education should and should not be about. Improving social and emotional regulation was not part of their definition. On the way home, I finished reading the last of J.M. Coetzee’s memoirs ‘Summertime’, in which he writes – in the third person – about his own schooling in South Africa: “….. he begins to recognise (in Dutch Calvinist educational theory) what underlay the form of schooling that was administered to him. The purpose of education, say Abraham Kuyper and his disciples, is to form the child as congregant, as citizen, and as parent to be. It is the word form that gives him pause. During his years at school in Worcester, his teachers, themselves formed by followers of Kuyper, had all the time been labouring to form him and the other little boys in their charge – form them as a craftsman forms a clay pot; and he, using what pathetic, inarticulate means he had at his disposal, had been resisting them – had resisted them then as he resists them now”. Reading this made me think. Is improving the well-being of children a dangerous game? Are the developers of social and emotional regulation and other evidence-based programmes any less socially manipulative or authoritarian than the neo-Calvinist Kuyper? On what criteria shall we decide? In my world, the yardsticks are need, ethics (including rights), effectiveness and demand. I accept the narrowness of my perspective, but to understand how limited and limiting it is, I have to know what wiser, more useful possibilities there might be. I don’t need a doctor to tell me I’m sick; I want to be made better. The sheer negativity of the criticism put me in a bad temper. It also struck me that many of the seminar participants seemed curiously willing to believe that whatever a government/local authority or school decides to do duly happens as if by political magic. In my world, it is much more often the case that initiatives inflicted on a community without ownership or engagement just wither away. As Coetzee learned to resist Calvinism, so today’s children and parents will not brook authoritarian interference. Friday 22nd May 2009 Monkhouse One-Liners carry Prevention Message Bob Monkhouse was a British comedian and chat-show host. He died in 2003. As he put it: "I've died many deaths. Prostate cancer, I don't recommend”. Before he died Monkhouse participated in a series of television and billboard advertisements designed to raise awareness of prostate cancer. The television advert carried a typical English music hall joke. "What killed me kills one man per hour in Britain. That's even more than my wife's cooking." This week I caught a cab in London. It was driven by a man whose life was saved by Monkhouse. Having seen the adverts the cabbie went to his GP and was screened. He was found to be high risk, and several biopsies later the cancer was found. Surgery followed and, six months later, Monkhouse’s greatest fan went back to work. Prevention. In action? Well early intervention actually, but heart warming all the same. Thursday 19th March 2009 Time we trusted the productivity of the evidence 'Opinion based discussions are more enjoyable; evidence based discussions are more productive.' I don't have much of a memory for quotations but, roughly speaking, that's what Sir Trevor Chinn, Chair of the Mayor's Fund for London, has been saying at several meetings to promote prevention in the UK capital. He's right. Meetings about prevention can be optimistic, exciting and forward looking. The same used to be true about similarly serious debate about the future of child protection in the UK. No longer – if the recent round is anything to go by. The latest crisis was rounded off last week by a report from Lord Laming whose previous inquiry in 2003 into the death of Victoria Climbié paved the way for some of the better developments in UK children's services. But it did not rid us of the failings in child protection, as was made evident by the avoidable death in 2007 of a child in the London Borough of Haringey. The death of 'Baby P' prompted a new Laming Inquiry. What did the report say? Child protection in some areas of England remains unacceptably poor. Many social workers are overstretched. There is too much emphasis on process and targets. The 'tick-box' approach to assessment, which was put in place to please government, undermines clinical practice. Communication between the agencies is poor, and funding is inadequate. Laming recommends child protection targets similar to those used to measure school effectiveness. There should always be a manager with child protection experience on a local authority senior leadership team. There should be a national strategy to address recruitment and retention problems in children's social work, and guidelines about caseloads. Social workers should get better training, as should Directors of Children's Services. Then there's the usual bag of sticks, such as unannounced inspections, disciplinary action, the striking of names from professional bodies, and also projects that allow government to give way with dignity – the abolition of court fees in care proceedings, for example. There's nothing in the report to which one can object. Unlike its predecessor it breaks no new ground, but at least it can be commended for not making matters worse. What is objectionable, however, is the largely reactive approach to child protection being taken by government, witness the latest inquiry. The world it reflects is one of potentially errant local authorities, policed by Ministers, kept on their toes by the media, driven by public clamour on behalf of the vulnerable. Not that long ago the approach was more constructive. In the 1980s the UK government worked towards a framework that would enable local authorities to protect children from maltreatment (and, after Laming at the beginning of the new century) promote their well-being. In this proactive model, government collaborated with local authorities to help the media and public understand the limits of state's ability to stop every outrage against children, and to build support for collective action if willful malpractice occurred. Haranguing social workers and their bosses and hounding them out of their jobs may be good sport for some. People are entitled to their opinions, but it is hard to see how trial and retribution can protect children from maltreatment, especially if it leads to a worse shortage of professional support. If I have an opinion on the subject it is that if these gross errors are anybody's fault, they are the fault of us all. And the response should be collective: it should anticipate the inevitable; it should not leave people flailing in the dark every time the inevitable occurs. Just as it began to be in the 1980s, evidence about the incidence, nature and causes of the problem and what is known to work in terms of prevention and intervention should be a vital aspect of the discussion. Tuesday 17th March 2009 Part of Dartington's work for the last couple of years has been to assist Birmingham, the largest local authority in Europe, in using evidence to improve the well-being of children. The work has achieved a lot of attention, due partly to the quality of data used to devise the Birmingham Brighter Futures strategy, partly to the inclusive way the plan was devised, and partly to the city's commitment to evaluate its innovation rigorously, and to share the results – good and bad. Particularly ingenious has been Birmingham's weaving of cost-benefit analysis into the business planning for children's services. Not only do they try to work out how much impact an evidenced-based programme will have on child outcomes, they also calculate how much it will cost and how efficiencies can be channelled into future innovation on children's behalf. They are also very smart about questions of fidelity, knowing that implementing an evidence-based programme badly is about as beneficial as not implementing it at all. News of these developments has seeped around the children's services world. And from time to time I find myself at a conference next to a delegate who asks me, 'Have you heard about what is happening in Birmingham?'. If I'm in a confident mood I'll answer 'No'. It usually turns out that the person in question has learned about the work by word of mouth, and that a certain amount has been lost in the telling. Still, the message is positive. Birmingham is an exciting place. Good things are happening. From my perspective Birmingham is a good place to work. It is led by hard working, clever people, who inherited problems that have plagued children's services around the world. They have been innovative and persistent in trying to sort them out. As they themselves would say, they have made a lot of progress but there is a long way to go. Part of the inheritance is the constant challenge of child protection. Because it's big, Birmingham has a high number of child deaths – about 175 a year. Most are perinatal deaths, and a high proportion are road accidents. No-one outside of Birmingham is much interested in these fatalities. But then there are deaths from child abuse and neglect. These run at about four per year, which is about the national average for an authority of Birmingham's size. There are generally about eight serious case reviews each year, covering serious injuries or other cases of public concern as well as potentially avoidable deaths. In August 2007 a baby died in the London Borough of Haringey. There was a scandal and the Director of Children's Services was eventually dismissed at the request of the responsible government minister, Ed Balls. An inquiry was commissioned from Lord Laming, whose previous investigation into the death of Victoria Climbié framed the legislation that enabled many of the developments in Birmingham. But the Haringey scandal has sent people sniffing for another 'big story'. And coming into view is a government league table that grades Birmingham as 'two stars, improving well'. This measure of children's services department performance has a scale of one to four stars on one axis and not improving adequately to improving strongly on the other. Local authorities are assessed according to their ambition, the strength of their strategy, capacity, performance management and achievement. These metrics mean a lot to government but not much to someone like me interested in the well-being of children. But they also interest a small class whose chatter is focused on children's services. So now when I meet people at conferences delegates ask me, with a furrowed brow, 'heard about Birmingham…?' Which version of the Birmingham question should prevail, the good or the bad? It's a plaintive plea, but how about replacing the emotion with careful inquiry? The death of any child is a tragedy. Can we reduce child deaths? Yes. Has the frenetic scandal-induced approach to policy produced any reduction in the rate of child deaths? No. How about a more epidemiological approach to child well-being, measuring health and development in the same way year on year? And how about using these data as the basis for innovation so that more children grow up healthy and safe? Will it work? For the great majority of children I think that it would. There is every reason to believe we can help more children to be protected from ordinary, day to day maltreatment such as being hit or shouted at unnecessarily. But what about the exceptional cases? The children horribly neglected or tortured by their parents? I liken these situations to plane crashes. They're rare, tragic and they strike fear into us all. What happens when a plane crashes? Do we persecute the pilot, or the air traffic controller, or the engineer who forgot to replace that last important screw? No. We have slow, careful, forensic investigation that leads to sensible recommendations that are implemented world wide. And the result? We still have plane crashes, and we always will. Most are the result of human error, and we cannot eradicate our capacity to get things wrong. But we can reduce error, and, in the case of plane crashes, we have. Over the last 30 years the number of deaths has slowly decreased. So next time I bump into somebody at a conference and they ask me if I've 'heard about Birmingham?', I would like them to go on to say 'they're using data to produce innovation that should improve the health and development of all children, and make them safer. And they're taking a forensic approach to the investigation of potentially avoidable deaths of children that occur each year so that their number will soon be counted on one, maybe two, but not all the fingers of a hand'. I would like to hear them say, 'They're using robust evidence to find out if they're successful. Hope they will be. Let's wait and see.' Is the UK closing the evidence gap? Tuesday 24th February 2009 I have spent the beginning of the week as Steve Aos's chaperon, a most agreeable task. His hectic schedule, typically American, is partly my responsibility so I feel the least I can do is help him get from A to B. Cost-benefit analysis on prevention programs has got itself a bad reputation. Good but small studies undertaken many years ago are the basis for claims that a single dollar (it is generally US evidence) will not only benefit children but also save tens of dollars further down the line. At first acquaintance the argument is persuasive, but the closer one looks at the original calculations the less convincing they become. But Aos has revolutionized the field. He has been analyzing the cost-benefit of interventions to improve child outcomes for a decade, and the evidence he produces becomes more compelling with time, not less. The standard of evidence is set high. Much higher than in the UK. But at the Cabinet Office seminar where he spoke on Monday there were clear indications that we are catching up, witness the experimental evaluations of Nurse Family Partnership. And there are real indications from politicians and senior policy makers that the gap will be closed. How disappointing then that another of Steve Aos's presentations was part of a conference organized by UK Government to promote its excellent work on programs like Multidimensional Treatment Foster Care (MTFC) and Functional Family Therapy but which in fact advertised poor evidence. Both programs are being evaluated by experiment. They work in the US and they should work in the UK. But we don't know. And we have to find out. The funded randomized controlled trials will tell us. But delegate packs at the Government funded conference contained reports from audits that demonstrate the progress of children enrolled in the MTFC intervention group. Impressive, but has it been more or less impressive than the control group? That's what we need to know, and presumably at some point we'll find out. But we don't know yet. It's understandable that Government should be keen to get its hands on audit data on the progress of children in the intervention group. But reporting it in isolation is confusing to a policy and practice audience still learning about the primacy – in an outcome-orientated world – of experimental evaluations, and just beginning to recognize how misleading results from studies without a control group can be.
When a workhouse culture can only mean wrong outcomes for children. Friday 20th February 2009 Working with a large US Foundation that is using Common Language to frame its future investments, a major challenge has been how to think about poverty. In the UK, there is a national health service and legislation in 1989 and 2004 offers a single set of orders and services for all children. The concept of progressive universalism allows for more of the same to be offered to children living in disadvantaged communities. There is an understandable desire to give more to the poor in the United States, but more tends to be services that fail to approach never mind pass the 'my child' test. This Common Language construct asks people working with children whether an activity would be suitable for their 'own'. On the 19th of February, The Guardian ran a leader that reminded me of how long we have been struggling with these ideas. It nicely combined UK and US expertise. A hundred years ago the seed that was to grow into the welfare state was planted, when Beatrice Webb and other members of a royal commission on the poor laws issued their minority report. It was a document which the young William Beveridge, then working as a researcher for Sidney and Beatrice, used as a template more than 30 years later when he drew up his own plan for universal welfare in the middle of the second world war. The Webbs … dealt an ultimately fatal blow to the idea that paupers were to blame for their own condition and that provision for them should be just above the starvation level, lest other morally weak individuals be tempted to join them. Hence the workhouse, an institution designed to offer no comfort, no prospects and no hope. The American sociologist C Wright Mills was later to observe that if one man in a city of 20,000 people is unemployed, his condition might be ascribed to the defects of character, but that if 1,000 are out of work, the fault must lie elsewhere. The Webbs underlined the structural causes of poverty and argued that the solution was universal provision of services by the state in all areas where citizens needed help. The minority report and the less radical majority report were rejected by the Liberal government of the day. Workhouses lingered on in various forms and the poor law lasted until 1948 -but Beatrice had already written its obituary in 1909. The US does not have workhouses. It is far too sophisticated for that. But it does link poverty to personal responsibility and it is reluctant to proffer help that could be seen as a reward for indigence. As a consequence, most services for poor children fail the 'my child' test. Reversing this situation must seem an impossible task. But my other reading this week has been Harper Lee's To Kill a Mockingbird in which the wise Atticus Finch reflecting on the probable failure of his defence of Tom Robinson against the prejudices of his society remarks: Simply because we were licked a hundred years before we started is no reason for us not to try to win.
Child deaths: no confidence is the worse danger Tusday 11th November 2008 Barry Sheerman, Chair of the House of Commons Select Committee, says he has lost confidence in the Government Inspector OFSTED over its handling of the Baby P case. The Chief Inspector, Christine Gilbert, has piled on the agony by reporting an annual statistic for child deaths three times higher than anything previously acknowledged. Before the next bombshell explodes it might be worth grounding ourselves in a few other hard facts; and reflecting on the likely downside of all this gnashing of teeth. Christine Gilbert's comments related to serious case reviews, carried out when a child dies or is seriously harmed, and maltreatment is known or suspected. The reviews are supposed to help agencies learn how to make a better job of protecting children. Too often they become an excuse to hound hapless social workers and their bosses – who are hapless or helpless not because they are at fault but because they are mostly not involved. Just 15% of the children involved in serious case reviews are on the child protection register when their lives are threatened. Serious case reviews are themselves the subject of biennial review. Between April 2003 and March 2005 161 cases were scrutinised: 106 concerned the death of a child, 55 related to serious injury. Very few of them could be described as being a consequence of calculated malevolence. About 70 children are murdered each year, usually by a parent or by someone who knows the child well. But these tragedies frequently compound other catastrophes, such as financial ruin and mental illness. In most cases there is a significant element of uncertainty. A child dies from head injuries: was it the result of violent shaking by a parent? Others suffocate in their parents' beds: were drink or drugs involved? One serious case review in every ten will examine an adolescent suicide. Nothing to do with the parent? Or was there something in the constriction of family relationships that drove him to it? Despite Sheerman's, Gilbert's and so many other commentators' agitation over the Baby P case and what it might tell us about the state of the nation and children's services, the statistics do not change much from one year to the next. Nor is there much difference between the situation in the UK and in other developed Western nations. But Sheerman is right to talk about confidence. In circumstances as fraught as these, children's services professionals lose confidence, take fewer risks and react more aggressively to potentially errant families. Families lose confidence in the ability of children's services to help. The confidence of Inspectors in local authorities also declines; they are just as likely to lose their jobs if they do not measure up, such is society's appetite for blame. And then what about all the Directors of Children's Services who look at the evidence and make a calculated decision to try to reduce maltreatment and improve outcomes for children? Might they not reasonably conclude that since violence and psychological aggression are the most common ways resorted to for resolving disputes in all families, rich and poor, that prevention ought to be the focus of the activity they manage? Supporting parents, helping children to relate to each other, improving emotional self-regulation might those be the sensible priorities? Might they not also conclude that although every attempt must be made to safeguard children from gross maltreatment, their power to stop such extreme incidents will always be very limited. They can predict the number of child deaths that will occur in their authority each year but those serious cases reviews will always be the record of a terrible lottery over which they have no control. But in this pretty dismal climate who would have enough confidence left to take such a reasonable, evidenced based approach? Slaves and Slaves Friday 18th July 2008 There has been much comment in the newspapers in the last month about professional footballers being treated like slaves. The argument stems from comments made by a leading soccer administrator about the Manchester United player Ronaldo. Acknowledged as one of the best players in the world last year he is reputed to earn over £100,000 per week. As far as I am aware this is a new meaning of the word slave. When reviewing Roy Parker's book Uprooted I used many strong adjectives to describe poor children emigrated unaccompanied by parents from UK to Canada between 1867 and 1917 but never got as far as enslaved. (Although many of the children were). The Journal Children and Society this week publishes a special edition on contemporary child slaves. There are articles on child labour and trafficking of children from across the world. A far cry from Ronaldo.
Turning the world upside down Monday 18th February An intervention to keep children in school in Debra Tabor in Ethiopia might appear largely irrelevant to the custodians of children's services in the economically developed world. The rather depressing caravan to Eastern Europe in the last 15 years suggests that the primary transaction between European and North American experts and the rest of the world is to instruct, not learn. As Emma Crewe's article in the forthcoming edition of the Journal of Children's Services demonstrates, the structure of relationships between the 'North' – the economically developed countries of the world – and the 'South' – the economically developing nations – stifles innovation and learning in all parts of the globe. Children develop in much the same way wherever they are raised. But the environments in which they are raised vary to an extraordinary extent. In the North we argue about definitions of poverty, but for too many children in the South poverty is about securing the bare essentials of survival. And often they live in societies where the rich are at least as well off as the wealthy classes in the North. Many environmental stressors that have been gradually reduced in the North, such as poor nutrition or the lack of accessible clean water, are highly prevalent in the South, while some new risks in the North – the vicissitudes of overabundance – remain relatively rare in the South. These contrasts are a scourge on our planet, but the scientist will also recognise opportunities to learn. The tragedy of life in the South means that environment can vary to a huge amount in a single lifetime. Losing parents and coping with man-made disasters, such as war, and natural disasters can be more common in the South than in the North. There are situations, in China for example, where massive economic development means that one generation lives a life much at odds with what went before. These rapidly changing contexts provide scope for a natural experiment by comparing children's health and development before and after the change. Since need generally exceeds the supply of goods and services to meet that need in the South, again by quite staggering amounts, there should be fewer objections to experimental evaluation. If resources to support, say, children's physical or emotional health in primary school are only sufficient to reach a small proportion of schools, then randomly allocating schools 'on' and 'off' the new intervention and comparing the two groups to detect its impact on children's well-being is as good a way of deciding priority as any. One would wish the situation otherwise, but where it exists the potential for learning should be exploited. The contexts of the South are particularly auspicious for studying resilience. Accounts of the experience of children's lives in the South are breathtaking for all the wrong reasons: crossing continents unaccompanied by parents, working longer than most adults in the North, becoming caught up in conflict and dealing with risks associated with the chaos that follows, and so on. But what is also striking is the significant proportion of children in these circumstances whose health and development remains relatively intact. The prevalence of depression, post-traumatic stress disorder and physical ill-health symptoms in high risk groups is high, but the majority do not succumb. The relative absence of children's services also produces opportunities. Attempts to evaluate service impact in the North is often handicapped by the clutter of provision and by the fact that some services, for example residential care, are as much historical artefact as meeting a need. They exist because they are there and finding out their contribution to children's health and development is seemingly impossible. Of course the same problems exist in the South, but to a much lesser extent. The opportunity to innovate in the South is probably far greater than it is in the North. Unfortunately too many opportunities to learn from the South about children's development and children's services are overlooked. First, it is too often assumed that children in the North and South are different and that the environments should be the same. But what if they are the same but their environments are different? For example, few would argue with children's right not to work. But there is too little interest in why children get into labour, how this affects their development and, until the causes of the problem can be eradicated, what interventions can be put in place to reduce developmental impairments for those that must work. There are exceptions, of course, for example the extraordinary work of PRATHAM in India (covered in the 28th of February edition of Prevention Action) to chart the incidence and possible causes of the problem and work innovatively to stem the flow of children into labour, provide education in the workplace and encourage a return to ordinary childhood or at least the home community for those caught up in the phenomena. Second, despite the regular episodes of huge environmental change in the South, hardly anything is known about its impact on children's health and development. Part of the problem is the assumption that change is short-term and negative. Look at the issue another way, though. Life in the United Arab Emirates has transformed over three generations, largely as a result of oil money and globalisation. Ethnographers have charted the impact on family life. But there has been hardly any interest in the relationship between the reduction in average income in the UAE and an increase in child health over the last decade. Third, despite the excess of demand for services in the South, there have been relatively few experimental studies. Worse, at the behest of Northern funders, Southern NGOs are very often required to collect data for soft evaluations that reveal little if anything about effectiveness. This state of affairs has caused prominent commentators to ask recently 'Does foreign aid really work?' Part of the motivation may be the belief that doing something is always better than doing nothing. But history is littered with examples of well-meaning interventions that have turned out to be harmful, and when resources are scarce there is a duty to find out which programmes reap the greatest return measured in terms of child well-being. Fourth, although it is common to remark on the resilience of children in the South, there is hardly any exploration of the concept and its contribution to children's health and development. Again assumptions get in the way. Anyone would be shocked by the living conditions of Palestinian children in refugee camps like Shatila in Lebanon. But few of us look closely enough at the huge commitment to education in the community, and nobody, as far as we are aware, has studied how children make good educational progress in such inauspicious surroundings. Fifth, as well as squandering opportunities to learn from the absence of services, there is a depressing assumption that Northern models and programmes are right for the Southern context. Liberal-minded people impose ideas on the South as freely and unhelpfully as the politicians they despise try to impose democracy. Changing the mindset, and looking to learn from the South, may help. For example, Cuba has introduced truly universal early years interventions. What can the North, which has majored on special programmes for the poor or progressive universal solutions that put more services in economically deprived communities, learn from this experiment? Unfortunately, too many of us labour under the impression that 'we' know and 'they' do not. The best-informed people know that we know too little and it is necessary to take every opportunity to learn. Learning from and with the South – about how children develop and how to design and implement effective services – can only help the North.
Deconstructing deconstruction Monday, January 28th The following review of Erica Burman's Deconstructing Developmental Psychology will appear in the British Journal of Social Work I can see the point of deconstruction. It is important that from time to time we hold up a mirror to the institutions that form the fabric of our life. In the day-to-day hustle and bustle we take so much for granted and overlook the often absurd aspects of our work. I also recognise the value of critique. Work challenges our lives - but it also pays our wages and makes us comfortable. Beneath the veneer of respectability lurks the possibility that our contribution to society is ineffective or at worst harmful. But when we have deconstructed something and subjected the parts to careful critique, the question is do we put it back together in the same way or differently? Erica Burman's book is a critique of developmental psychology, an edifice she regards as more powerful than any other branch of psychology in the way it influences our everyday lives and the way we view ourselves. This second edition of the book, first published in 1994, is revised and updated to take account of changes in thinking about children - for example greater attention to their rights; changes in our knowledge about human development – for example better understanding about the contribution of genes, the way the brain works and theories of attachment; and the broader focus of academics employed in the deconstruction business. This now includes, for instance, education and pre-school provision. At the heart of the book is the idea that a series of unequal power relationships – between women and men, between children and adults, between the family and capitalist society, between the South of the planet and the North – are sustained through institutions whose stated objectives makes no reference to power. Developmental psychology is one of these institutions. The book makes the reader sit up and reflect about the morality we seek in society. In my case, it set me wondering not only about the contribution of developmental psychology to that morality, but also to children's services more broadly. But there is also some artifice in the deconstruction process. The point can be illustrated in Burman's critique of evidence on genetic transmission and the way our biology may determine our future. She reaches to Michael Rutter's 2001 Presidential address to the Society for Research in Child Development for support. A quote is selected on the limitations of magnetic resource imaging (MRI), a technique for looking at what goes on inside the brain. But the quote is part of a long exposition expressing doubts about many aspects of the sciences that contribute to our understanding of human development but which then concludes with an agenda that espouses almost everything Burman seeks to deconstruct. Part of the artifice is overlooking the constant internal critique taking place within the scientific fields that make up developmental psychology and which, in the case of Michael Rutter, can be more withering than most people looking to deconstruct the discipline can contemplate. Indeed other realities – no more or less valid or unsound as Burman's – can be put forward. So constrained are the disciplines of developmental psychology by the rigours of reliable evidence that it is difficult for outsiders to know what it is saying. In fact there probably is not an “it”. Developmental psychology is more a case of groups of people with supporting and contradictory evidence hovering on the fence that divides fact from opinion and hypothesis from action. Contrary to Burman's view, many people will view developmental psychology as lacking power and wielding less influence over policy and people's lives than it probably should. For example, much is known from developmental science about effective parenting techniques. Burman's critique might conclude that they are repressive - and she may be right. But my conclusion would be that the scientists cannot agree on the primary messages, that policy makers decide what to do and find the evidence to support their argument and that most parents muddle through as best they can largely oblivious to science and policy. I enjoyed this book. It made me think. It set me off deconstructing social work, schools, mental health and other parts of children's services. But it led me to conclude that constructing these institutions is a long and messy business involving many people who barely understand each other and seldom agree. Construction is a social process with a long history. Burman's deconstruction is a little too swift and solitary. Deconstructing Developmental Psychology, 2nd Edition, Erica Burman, London, Routledge, 2008, pp. 356, ISBN 9780415395618 (HBK), £19.95
What the Centre does Well 20th December 2007 About 18 months ago I was invited to a meeting of politicians, senior civil servants, and local government leaders. The discussions were wide ranging, but the underlying theme was the relationship between central and local government. My interest in this topic is in providing a language -a way of thinking- that facilitates innovation by people who ordinarily would not work with each other, and who tend to undervalue evidence and the need to rigourously evaluate. At the time of the meeting, the zeitgeist was beginning to change. Enthusiasm for the New Labour 'project' was subsiding. Central government was beginning to recognise itself as over-bearing. Local government was becoming increasingly vocal about having to deal with central government initiatives. Since the meeting, the mood has intensified. The Prime Minister is regulalry lampooned for being 'Stalinist'. Evidence about the effects of initiatives dreamed up and driven from the centre (of government) is patchy and often negative. Data on the well being of the UK's children paints a less than rosy picture. In the 18 months since the meeting there has been little substantive change. The number of central government targets has been reduced. But the stream of legislation, guidance and reports from Westminster continues to be overwhelming. So what does the centre do well, and what does this tell us about the relationship between central and local government? Children's legislation, policy and guidance issued by central government has the potential to influence all children. Such even handedness demands concept. It requires well worked out ideas. Too much central government activity in recent years has been what philosophers would call empirical. To give an example. The Children Act, 1989 re-defined the relationship between the state and families with children. It created a single threshold to permit state involvement in family life. It established a single set of orders to cross private and public law domains, so that children caught up in divorce proceedings and those being placed in foster care would benefit from the same legal response. The new law required that local government pay greater attention to the rights of parents. But it did not specify how local professionals should interact with parents. Nor did the law specify how the state should intervene once the threshold has been passed. What makes the 1989 legislation strong and enduring is the depth of the ideas that underpin it. Brenda Hale undertook ground breaking work at the Law Commission. There was extensive consultation with politicians, experts and other professionals facilitated by the then Department of Health and Social Security. It should be unsurprising therefore that the Children Act 1989 has good concept. Some of the same could be said of the Children Act 2004, which introduced the idea of a single set of children's services organised to improve children's health and development. But the 2004 legislation does not stop with the concept. It goes much further than child outcomes. It specifies the outcomes to be achieved. It leans strongly towards a specific structure for integrating services. And, in the implementation phase, the government has promoted interventions that it thinks will achieve the outcomes. The concept soon gets lost in the empirical. Part of the vitality of children's services -possibly any public service- is local ownership and innovation. The potential for Manchester to find different ways of improving children's health and development from say Leeds has to be a good thing. Especially if we can learn from the variation. So what could the centre best do to help? It could spend more time on the ideas and less time on the detail. Fewer missives will create time to think more carefully. It should focus on the big picture questions, and make time to arrive at a well thought out, evidence based and broadly supported representation of the concept locally. Sponsoring innovation should also be high on the agenda. We know so little about child development, and what works in improving child well-being. Local innovation, well framed and rigorously evaluated, provides an important avenue for learning a little more. Sharing the results of evaluation should be a critical part of the central government role. Before we get carried away with the excitement of letting a 1,000 flowers bloom, let us not forget that some do not bud. In any country a small proportion of local government areas will fail in their basic duties. In any local authority, a small proportion of services - such as children's centres and schools - will fail. Part of central government's role is inspecting to ensure the law is obeyed and minimum standards are met. And that includes, responding to scandals, and seeing their wider significance for the well being of children. But that should not turn into micro-managing every aspect of children's services.
Reductions in avoidable child fatalities: learning from mistakes Monday, November 26th The Michael Sieff Foundation has long established a reputation for bringing together people who would not otherwise meet in a context where they will discuss issues they might otherwise avoid. The Foundation has been influential in the shaping of several pieces of children's legislation from the late 80s onwards. Their meeting at Cumberland Lodge in Great Windsor Park on 19th to 21st of November, marking 20 years of the Foundation's work, promised to enhance the reputation. Sir Al Aynsley-Green, the first children's ombudsman in England, delivered the Michael Sieff address. The need for a children's ombudsman has been a constant refrain of the Sieff conferences. The need to boost the powers and the resources available to Aynsley-Green featured strongly at this meeting. I have always been ambivalent about a need for an ombudsman. It is good to have a voice for children. It is good to have external scrutiny. But we shouldn't need an ombudsman to point out, as Aynsley-Green had to point out, that children being ferried between secure settings have to urinate on the floor of the van that carries them. Or to speak against the introduction of restraint procedures that would be doubtful in the context of adults, never mind children. But children have limited political currency in the UK. And so it seems we need an ombudsman to attempt to redress the balance, and to work alongside the various inspectors of children's services. Inevitably, success requires a measured political response. This was exuded by Aynsley-Green's presentation. But two facts captured my imagination. The first juxtaposed a significant fall in fatal car accidents involving children with the significant decline in children walking and cycling to school. The slides presented by Aynsley-Green gave a broadsheet newspaper as its source. So I decided to check the evidence. The paper by Carolyn DiGuiseppi and colleagues from the Institute of Child Health, University of London in the BMJ in 1997 (8th March) is as good an illustration as any. They found that between 1985 and 1992 the average distance walked in a year by a child aged 0-14 declined by 20%, and the average distance cycled declined by 26%. In the same period, deaths caused by cars to child pedestrians fell by 27%, to cyclists by 38% and occupants in motor vehicles by 21%. It has been well reported (often as part of a growing panic about obesity) that fewer children are walking to school. But it is less well known that fewer children are dying on the road. (These two facts may or may not be related). The second point of interest was an analogy between progress on avoidable deaths of children known to children's services, and reduction of fatal air accidents. About 100 children known to children's services die each year. Although each death is a tragedy, I had come to conclude that reducing the number was improbable. Perhaps Government thinks the same because, as Aynsley-Green pointed out, reports about lessons learned from inquiries into child deaths are several years behind schedule. The number of people traveling by air doubles every decade. But the number of people dying in aircraft accidents has slowly declined over the last several decades. (From an average 61 accidents causing 1,672 deaths per annum in the 1970s to 47 accidents causing 1,207 deaths in the 1990s). Why the decline? Every air accident is rigorously studied, and lessons are applied by an otherwise cut-throat, sometimes hand to mouth, industry. Is it beyond our wit to set up an accident inquiry system that will produce learning that can become part of routine practice in children's services? http://aviation-safety.net/statistics/period/ http://www.michaelsieff-foundation.org.uk/
Protecting Indigenous Children by Protecting All Children in Australia I was recently invited as keynote speaker at the 11th Australasian Conference on Child Abuse and Neglect held at Gold Coast in Queensland. Prior to visiting I had interviewed Fiona Stanley, leading public health expert and rights advocate from Perth, for Prevention Action. She told me how, as a young doctor, she had worked to bring sick Aboriginal children to the hospital in Perth where they got better, only to get sick again in the home communities. It was these experiences, coupled with training with Jerry Morris that led to a life-long commitment to public health. Click here to view prevention action blog In Australia I was arguing for much the same with respect to child protection; that a shift in ordinary parenting practices would achieve at least as much as current responses to the generally poor families drawn into the child protection system. On arrival in Australia, the taxi driver collecting me from the airport asked "you must be here for something important to come all the way from England?" When I told him about the conference he said “ Oh yes, child protection is massive issue here in Australia" and he proceeded to talk for about 20 minutes about problems in the indigenous communities. Later on, talking to child protection workers in Cairns it was suggested that between a quarter and three-fifths of the foster care population -depending on which part of Queensland was being considered- were of Aboriginal decent. People from Britain are hardly in a position to lecture other countries on questions of ethnicity. But it seems to me that any jurisdiction that has over a fifth of its care population or child protection referrals coming from a single minority ethnic group is failing all of it's children. Put another way, I would venture that such a high proportion from a single minority ethnic group indicates a failure of society to equitably provide basic health, education and social services systems, as much as any failure of the minority group to bring up its children. The conclusion has troubled me. Why should it be true? Generally speaking, child development does not vary hugely from society to society. There are important differences in parenting practices, but practices that are harmful to children are relatively consistent. It seems highly unlikely that there is anything in Aboriginal culture that is disproportionately harmful to children. But the harm caused to Aboriginal culture, the taking of land, movement of peoples, banning of languages, exposure to disease and forced separation of children would be expected to change parenting, and undermine other social supports necessary for healthy child development. Many of the policies just described are, I would hope, largely historical. But the effects remain. My guess is that Australia is tackling the problem at the wrong end. As well as working to protect children from maltreatment, it also needs to address the risks that lead to maltreatment, such as poverty, social exclusion, weakened mental health services, disrespect for cultural difference et cetera. The taxi driver might argue 'why should we do more to support the minority?' One could produce a good rights argument. But more persuasive would be evidence of the negative effect of inequalities on the well being of children and adults in the majority culture. Put more plainly, getting this right would benefit the taxi driver's children as well as the maltreated children from indigenous communities about which he hears from the many 'Talk Radio' programmes.
Children See, Children Do – can media help? A theme running through this year's ACCAN conference has been child protection as a public health issue. What are the opportunities to improve the protection of children in all families? And how might that kind of strategy benefit children whose unfortunate experiences are at the extreme of the continuum? The bigger question is how to achieve whole-population protection? There are universal programs, such as variations on the Triple P parenting program reviewed in Prevention Action on 1st November [See: Accentuating the positives with a Triple P.] Action by government to change the pattern of family life, for example by altering the work-family life balance, could also be counted as a public health initiative. Another potential avenue is involvement with mass media – and, in that connection, in between conference sessions last week, delegates had the opportunity to watch an Australian TV advert funded by the National Association for the Prevention of Child Abuse and Neglect (see link below). Children See, Children Do shows children shadowing and mimicking parents, talking on the phone, getting impatient while waiting for a train, smoking, exploding with rage, and so on – all to shed light on the aberrations of adult behavior when seen through children's impressionable eyes. I don't know enough about advertising to judge whether Children See, Children Do can be effective. We know that at best this kind of approach will have an impact on about two per cent of the population. But since television viewing is so universal, two per cent represents a lot of parents. http://www.childfriendly.org.au/streaming1.htm
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