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What I mean to say: fit for purpose

10th January, 2012

Just before Christmas, UK Children’s Minister Tim Loughton commissioned a review of the adoption process. His advisor, Martin Narey, had become “exercised …. about (the) parental assessment process which is”, he said, “not fit for purpose”.

‘Not fit for purpose’ is, as far as I can work out, a recently invented cliché. I suppose a cliché by definition should have a certain vintage, maturing through over use from meaningful observation into banality. But some words and phrases are quicker to triteness than others, and ‘not fit for purpose’ has made the journey at the double.

Take away the negative, add a question mark and we are left with ‘fit for purpose?’ a routine quality assurance test. But whereas ‘fit for purpose?’ is asked of a specific part of a process, a cog in a system of wheels, ‘not fit for purpose’ is an adjective applied to the organisations on which society has come to rely.

Its intention is to shock. The Home Office, prior to its break up, was ‘not fit for purpose’. The European Union, say the eurosceptics, is ‘not fit for purpose’. The failure is not a part of the organisation, a department or leader, it is the whole damn system. ‘Blimey, I didn’t know that, thank goodness someone is going to put it right’ is the requisite response.

The riposte should be ‘what purpose’. The European Union seems to be implicated in near-on 70 years of peace in a continent that has specialised in war, so maybe it is suited to this purpose. On the economic front, capabilities are rightly being questioned.

The purpose in doubt with respect to adoption is its ability to supply middle class childless couples with healthy children from working class homes. As Minister Loughton put it,

"We cannot afford to sit back and lose potential adoptive parents when there are children who could benefit hugely from the loving home they can provide”.

Another purpose of children’s services is to ensure that working class parents are not deprived, because of temporary incapacity, from the opportunity of providing a warm supportive upbringing for their children. Another is to weigh the risks of things going wrong with the birth family against things going wrong with a foster or adoptive family. That middle class families are as vulnerable as working class families to incapacity or death, and as able to screw up their children, or to be screwed up by their children, is one of the great inconveniences of modernity.

Social workers are being asked to make life changing, in some cases, life saving decisions. I am sure I would, as Narey put it, ‘meander’, when faced with such huge choices. And I might slow to a complete halt if my decisions were constantly being questioned by unqualified people like me, the Minister or Narey.

What the high ups can do is to be clear about the purpose and to stop second guessing ‘fitness’. With a bit more clarity, maybe the practitioners would have more confidence to act.

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Finlandia: What’s essential and what’s optional in the quest to improve children’s lives?

22nd November 2011, Manchester

To the British liberal eye, Scandinavia is an idyll as perfect as that painted in Sibelius’s short symphony Finlandia.

Recent terrorism, the emergence of nationalism and the unsettling effects of Stieg Larsson and Henning Mankell scratch at the surface but the beautiful vista remains undimmed.

By most calculus, the Scandinavian states do more for their citizens than we do in the UK. The argument goes that doing more would make our children, our people, happier and healthier.

But it is interesting also to look at what apparently successful states omit.

Last week the Social Research Unit hosted a visit from anti-bullying expert Christina Salmivalli from Finland. Part of the story was about addition. She reported on how her well-crafted, rigorously evaluated bullying programme had been implemented, effectively so, and at scale. It is another Scandinavian success.

But the back story covered some of the things Finland does not do that the UK does. Finland does not have school inspectors. There is no equivalent to OFSTED.

Finland does not give parents or students choice about which school they attend. You go to your local school. It's not a command, it's just what you do. There is no testing. In fact the first real exam is at matriculation, when students are 16 years old. No SATS in primary school, and none in secondary school. Not that there is much primary school to speak of. Finnish students don’t really get around to learning how to read and write until they are seven years old.

And to round it all off, Finnish teachers are not told their raison d’être is to produce super smart graduates. The task is to prepare students for life. The product of this laid back approach to schooling is the smartest students in the world. Finland regularly tops the widely respected OECD PISA survey of scholastic performance.

In many ways I am resistant to these idylls. Sibelius is ok. Finlandia is quite nice and only seven minutes long. But most of the symphonies go on and on and are relentlessly uplifting or lovely.

But it did set me off wondering what would happen if we abandoned all inspection in a dozen or so local authorities. What if we gave OFSTED a school holiday and a social care break for a couple of years. Would the world come to a halt, and if it didn’t could we spend some of the savings on prevention or early intervention? And if we abandoned the commitment to choice in another handful of local authorities, would parents or pupils rise up and revolt, and would standards plummet as we have been led to believe?

If we went about this exorcism of choice randomly, we could find out, and potentially save a few bob. Or is this just another idyll, a fantasia maybe?

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Family Nurse Partnership Annual Study Day

22nd November 2011, Manchester

In today's Family Nurse Partnership Annual Study, I addressed the audience with the following talk:

 

"It is a great privilege to be invited to speak at the FNP National Study Day. I suppose I would count myself as FNP’s number one fan, except that many others will be vying for that position.
There are lots of things I want to say, but I only have 20 minutes. So I will just draw out some highlights.


Achievements
We are having the toughest of times for over a century. You work with people who feel the economic downturn most. But your achievements are significant. Over 6,000 families receive FNP. That is a market penetration of 10 per cent. In the US I reckon that after about 30 years they have reached 15 per cent. So you are really motoring.


More importantly, the replication of the model has been strong. We know this from the Birkbeck research. For the most part -there is always room for improvement- FNP has been implemented as it should be implemented. That is crucial for delivery of better outcomes for mother and child.
By now, so skilled are you at this work, you probably do not think this is such a big deal. But I can remember the host of other government initiatives that broke all the rules:


- For example, those that had no evidence base

- Those that lumped together several evidence-based programmes willy-nilly

- Or where volume was put ahead of fidelity.


With one or two notable exceptions, nearly all of these efforts resulted in zero impact on child or family outcomes, and most are long gone and forgotten.
Even now we are not supposed to talk about these huge errors of government. Millions of pounds were wasted by taking perfectly good products, dismantling them and then re-assembling them badly.


It was FNP’s good fortune that it fell into the hands of sensible people who put what was right ahead of political expediency.


Money
We can argue about the figures but roughly speaking the state spends about £5,000 per child per annum. It doesn’t sound like a lot, but nationwide it adds up to about £55 billion.
And at FNP you are asking that we blow £6,000 on a single intervention. It is a big ask. It is a credit to those of you seeking commissioning that you have made the case. Your job must have been difficult, and it has been getting more difficult, and it will be more difficult still as the recession continues to bite.


If we were informed gamblers, we would see FNP as a safe bet. Yes it's a reasonably big outlay, but the returns are significant. The econometric model that Dartington has been developing for the UK calculates that each £6,000 chip is going to bring in about £16,000 of returns.


Why? Because FNP mums are more likely to go back to work. Because child protection concerns are decreased by over a half. Because in the long run the children are more likely to do well at school and less likely to bother youth justice services. Because mother and child are healthier and make fewer demands on the NHS.


Since we are cautious souls, we run what we call a ‘Monte Carlo Simulation’ in our models. This is like saying, 'I know I might get lucky on the casino tables one or two nights in a row, but what would happen if I played for 1,000 nights, including those times when everything was going wrong'. And it turns out that 99 times out of 100 FNP will always pay off.


These kinds of calculations have led to different ways of thinking about commissioning. We have helped local authorities to make investments that not only improve child outcomes but also generate an economic return. Social finance organisations are bringing private finance into the equation. Payment by Results turns the outcomes into pounds and pence.


FNP is a slam-dunk, home-run, and every other type of cliche you want to apply to an investment that is bound to pay-off. I would put my money into FNP tomorrow if the mechanism existed. The commissioners in the room will be exploiting these opportunities, and getting social care, schools, and youth justice to invest as much as the health service has invested, knowing that they are going to be primary beneficiaries.


Culture
What helps FNP is your sober approach to evidence. There is a culture of not over-claiming. Don’t lose this.


Recently I went with a venture philanthropist to a large UK city to reflect on potential investment opportunities. Each programme we saw claimed, in the absence of any credible evidence, to be 70 per cent successful. Whenever I hear the words ‘my programme is 70 per cent successful I zone out since I have never encountered anything that was 70 per cent successful.


When we got to FNP, we were told that although FNP had been subjected to three experimental trials, all showing significant effects on child outcomes, the UK evaluation was still underway. When the venture philanthropist asked about Group-FNP, he was told this was still very experimental, under development and some way from being ready for prime-time.


It was a breath of fresh air. And for a venture philanthropist today and I suspect for public sector investors in the future, it injected some predictability into a series of conversations that have been marked by guesswork. The need for honesty, predictability, transparency is going to feature strongly in future commissioning conversations and I urge you to hold on to your values.

Scale
My current passion in this work is helping to take some proven models to scale. In the UK we have many many interventions, few of them proven, some of them harmful, a handful like FNP backed by strong evidence, and none of them scaled.


In the same UK city I visited with the venture philanthropist, there were 100 FNP places to meet potential demand of 350. Scaling up in that city meant finding another £1.5 million. Another big ask.


But the advantages of scale are huge. Not only are more children and parent served but a public health effect is produced. Parents who don’t come anywhere near FNP begin to behave like FNP parents. A contagion is produced.


So, to my mind, I am asking, instead of funding 10 things, nine of which have at best a dubious evidence base, why not scale two or three things in which we have most confidence.


So whereas Kate and Ann rightly have their eye on the prize of 60,000 places England wide, I am hoping you have your eye on scale in your locality. That might be just 50 places, or three to five hundred in a big city. If you can do it, you will be the first people in the world, to take an evidence-based programme to scale, and to bring all the benefits for families that this promises.


The challenge of scale is huge. As a general rule of thumb, most things proven to work have not been scaled, and most things taken to scale have not been proven. I recently helped to convene a major conference on the subject at the Gates Foundation in Seattle and here are some of the things I have learned.


First, scaled products are personal products. So while evidence-based programmes like FNP demand fidelity, scaled programmes will require adaptability to suit the user. We can do both, but it takes a little extra thought to work out how.


Second, people don’t want to know how something works, they just want to know what it will do for them.


The iPhone is a good illustrator of these two points. We don’t want to know how it works, just that it will make calls, link to the internet, play music etc. We make an iPhone our own. We personalise it.


People don’t need to know how FNP works, just what it will do for them. And your secret weapon is the relationship between nurse and parent and child. This is the personal bit.


For those of you responsible for managing FNP, similar personal connections are needed with systems folk commissioning FNP. They need to feel they are bringing something specific to meet local needs, something that preserves the fidelity of the core but allows adaptability around the edges. Something that allows an added dimension designed with Manchester, or Newcastle, or Preston in mind. Context is king in the world of scale.


Third, stories matter. Numbers, trials, effect sizes etc matter. They really matter. But once we know the evidence, we can engage hearts and minds by telling the stories to which human beings, parents, relatives, social workers, general practitioners, relate. This, in my experience, has been a strength of FNP in the UK, and you can use it to greater effect in the scaling process.


Fourth, most successful scale-up links a product with a process.


The combine harvester, that transformed the US from a largely agricultural to a largely industrial nation, was linked to the invention of hire purchase. The Ford Model-T was linked to mass production.


Toyota, the worlds most successful motor car company, 60 years ago a sewing machine producer, is linked to ‘Just in Time’ technology.


Microsoft, the world’s greatest scale up triumph, is a product of two big bets paying off at the same time. Bill Gates bet on Windows software. His colleagues bet on packaging that software so that it could be licensed and sold with any computer, meaning they did not have to be computer manufacturers. FNP is the world beating product. What process is going to help us scale it?


Messages for the Workshops
I will close with some messages for the workshops that follow. I cannot comment on the organisational aspects of the work since that is well outside my expertise, but there are some messages from research that might be relevant for the other groups.


Quality improvement is going to be a recurring theme in the next decade. It is intrinsically tied to the question of scale. Public expenditure will get progressively tighter. We can cut or we can get better at what we do well. Scaling evidence based programmes like FNP is on the getting better at what we do well side of the equation.


I have urged commissioning strategies that seek local scale up of FNP. The first person in this room to meet the needs of every high risk, young prospective mother will be the first person in the world to scale an evidence based programme. I am betting that the returns will be much greater than the benefits that accrue to the mothers who are supported, that there will be a contagious effect. If you are on this journey to local scale, give me a call because I want to be on the journey with you. Its the next big frontier.


Your achievements over the last four years have been remarkable, and this makes sharing the learning difficult. We don’t embrace success in this country. But your sober approach to implementation, respectful of evidence but putting the child and family first, should be hugely instructive to the children’s services workforce. To me this is more than sharing ‘top tips’, its about making the best practice routine practice. I really hope there may be some investment in this task.
On data collection, you have, unlike most children’s services operations, good data. You probably have too much. The challenge is reduce it to the information that the nurse and the mother really need to know in order to achieve the best outcome for the child. This will be a defining challenge in children’s services in the next decade since we collect too much data and do too little with it. Its draining our resources that could be better invested in kids.


Safeguarding. There is a simple message here. FNP is, to date, the best proven model for preventing child abuse. By far. It is fantastic that the Health Service has invested so heavily in FNP but I am hoping that social care will become the major purchaser since your product is the best on the market for reducing avoidable harm to children. Yes, you have to get your safeguarding right, and you will talk about this in your groups, but don’t lose sight about the intrinsic safeguarding capabilities of FNP.


And let me finish on relationships and encouraging positive, sensitive parenting. Conflict in families in ubiquitous. Living with other people is not easy. About five per cent of families resolve this conflict using violence. Not minor violence, severe violence. Most of these families are unknown to children’s services, and the damage to children in terms of clinical disorders is considerable.
Most of us resolve conflict badly. We resort to psychological aggression, we use minor physical violence, for example slapping our kids. This is the norm but it is not healthy. It elevates the risk of conduct disorder for children three-fold. This is not a problem for other people’s children, it is a problem for most of us in this room.


So for me, another scale challenge, is how do we take the components that have made a programme like FNP so successful, changing the behaviour of the most at risk new parent, and translate them into a form that we can reach every new parent. How do we spread the idea that ordinary conflict in the home can be resolved with a little more awareness, more mindfulness and little less angst, and getting our own way and hitting.


This public health approach to child protection, changing what all of us do at home, has the potential to radically improve the well-being of UK children.


Conclusion
I hope those remarks were of some value to you. FNP is arguably the best evidence based programme available. The implementation in the UK has been exemplary. Its a success story. So lets break the habit of a lifetime and celebrate. But more importantly, lets use the success as a platform for the next challenge. For me that is scale. Not so much 60,000 places, which seems unattainable at the moment. But achieving scale in a number of significant places, say here in Manchester, or Birmingham, Nottingham maybe. The place doesn’t matter as much as achieving this more modest goal and estimating the value added by virtue of the contagion and other public health effects produced. I very much hope some of you will make that important journey."

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We Can Work it Out

11th November 2011

Bill Gates stares out of a Rotary International poster and tells us ‘We are this close to ending Polio.’ His thumb and forefinger are placed either side of the words ‘this close.’
Gates is making a huge contribution to this dream. As, no doubt, are Rotary International. But it was the pronoun ‘We’ that caught my eye. Eradicating Polio demands that a lot of people do something different.

The poster caught my eye at the airport as I returned from the convening on Achieving Lasting Impact at Scale organized by the Bill and Melinda Gates Foundation in Seattle.
We had been reminded that we know how to reduce infant mortality but we haven’t figured out how to get the solutions widely taken up. Exclusive breast feeding in the first two years of life saves lives but few mothers start never mind persist in nursing their own children. Chlorhexidine kills the infection that spreads from the umbilical chord to the new born child. But how do we get this simple, inexpensive, antiseptic to every birth place?

There was an impressive ‘We’ at the Gates convening. Experts in child health sat alongside business leaders. Politicians and policy makers shared the platform with media experts. Most branches of academia were represented, and participants came from all corners of the globe.
Most will have left reflecting on the need to collaborate and to think anew. Experts like to think they have the solution, when in fact most solutions are the product of several experts.
We know that telling people what to do in order that they and their children will lead healthier lives seldom works. So how do we change our habits with a view to tracking down innovative ways of getting people to demand health enhancing products and practices?
We learned that the personal approach pays dividends. But how do we mass produce the personal so that we can help recipients of innovation to be determinedly individualistic whilst adhering to emerging health enhancing norms?

I cannot work out the solutions to these problems. And nor could the participants at the Gates convening in the short amount of time allocated. But with more time and more collective effort progress should be possible.

We know what works and we continue to invent new ways of improving global family health. But preventing eight million under five deaths each year requires a new expertise, the scaling of proven products and practices. We don’t yet know how to do this. But We can work it out.

Michael Little is co-Director of the Social Research Unit at Dartington, an independent foundation dedicated to bringing science to bear on better child development. Dr Little assisted in the facilitation of the Achieving Lasting Impact at Scale convening organized by the Bill and Melinda Gates Foundation in Seattle in November 2011.

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Separate but connected?
10th August 2011

"There are pockets of our society that are not just broken, but frankly sick," said David Cameron on his return from Tuscany. Like the Prime Minister I have a strong belief in the power of communities to improve human development, and child development in particular.

But the condemnation of young looters, echoed by Ed Milliband as he took his photo opportunity in front of a group of broom bearing youngsters in Manchester, only serves to disconnect those who are already unhinged.

Hoodies and their tattoo bearing, cigarette smoking, borderline obese, single mothers are an easy target for a moral majority. But these young people and their families also constitute a community. They hold often unpalatable views, not least the aggressive, unrepentant, young man captured on television news this afternoon putting it all down to the ‘Poles taking our jobs’.

Progress will come not from denouncing these communities but by forging connections. The most remarkable contribution today came from Tariq Jahan whose son Haroon was last night murdered during unrest in Birmingham. Tariq called for an end to violence that threatened to escalate into racial strife between neighbourhoods.

There is a power in communities that can be unleashed for good and for bad. A healthy community will understand that we are separate but connected to a broader society to which we hold obligations.

Parts of our society must change. But none, whether they be bankers who broke the bank or young thugs who want to break into the bank are going to be told what to do. We must provide incentive to change.

In the days that come, our political leadership might remember its responsibilities to those who Cameron labels as ‘sick’. Inequalities in wealth. The failure to sponsor social mobility. The narrowly drawn political elite. These are among the many symptoms of the illness that lays low our society. The remedies are hard pills to swallow.

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Response to the response
19th July 2011

Four reviews. One response. Two more reviews promised. There has been a lot of reflection on how to better support child development since the Coalition Government was formed 12 months ago.

Today, Education and Health Ministers Sarah Teather and Anne Milton published their reaction to the reviews commissioned from Labour MPs Frank Field and Graham Allen, Action for Children Chief Clare Tickell and LSE Professor Eileen Munro (the 19th of July, 2011). The detail is set out in Supporting Families in the Foundation Years http://www.education.gov.uk/home/childrenandyoungpeople/earlylearningandchildcare/early.

Perhaps the most significant aspect of the publication is its’ authors. The drive for change has been coming from Treasury, Number 10 and the Department of Work and Pensions. But it is the owners of children’s policy, Education and Health that have provided the primary reaction. This may or may not signal future priorities.

The four reviews produced a lot of requests for action and it is impossible for Government to respond favourably to all of them. The initial reaction is broad. Inevitably it backs the things to which Government is already committed, the expansion of Family Nurse Partnership for example. There is strong backing for more information for parents, a better trained workforce and a shift of resources towards the most disadvantaged.

There is nothing here to argue against. But the aspirations may be too broad to be useful, and some of the things that matter most may get shunted down the list of priorities.

My contribution to these reviews, a lot with Allen and a little with Munro and Field, has been a call for a higher standard of evidence. The Government response indicates a shift in the right direction. But it is far from all embracing perhaps reflecting the anti-body reaction that this injection of science has produced.

Maybe Teather and Milton have judged this right. Interventions selected by a high standard of evidence are potentially part of the solution to impairments to children’s health and development. They are not the entire solution. And we have to further test the potential. As long as evidence-based programmes and policies are not being kicked into the long grass, to borrow a favourite Whitehall phrase, then we are doing well.

The test will be the extent to which Government backs or at least does not impede the creation of an Early Intervention Foundation to provide independent standards of evidence, identify programmes and policies that pass muster and support new financing arrangements to see if the potential benefit to children can be realised.

One recognises in Teather and Milton’s report the cleft that Government must stand over. One line takes us away from telling local authorities what to do. The other line demands that we all do one or two things to improve the lot of England’s children.

The join requires proper experimentation at a local level, and an honest sharing of results so that others can pick up what is successful. Science, truth and embracing failure are necessary ingredients to make this work.

The cleft also highlights the need to develop a social contract regarding child development. Little is to be gained by telling people what to do. Nobody has ‘a’ solution to the ills visited upon our children. We still lack consensus about what we agree on, what we need to learn and how we can test innovation.

The glaring gap in both the reviews and the government response is innovation through subtraction. Everyone wants to add (in a time of economic adversity). Nobody wants to acknowledge that some progress depends on taking away that which is harmful (and testing the extent of its harm along the way).

The great triumph of this process, the reviews and the response, has been the way it has crossed party political interests. Child development is not going to be enhanced by voting left, right or middle. The political parties can help by approaching child development in a non-partisan manner. That reviews were commissioned from two Labour MPs and the response came from the Coalition parties is a significant step in the right direction.

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Evidence Based Programmes, Child Protection and Munro

Blog entry: May 11, 2011

Eileen Munro today published the third and final part of her review of child protection for UK Government. She writes about the value and challenges associated with evidence based programmes, and is cautious about their value. The report includes a large quote to some notes that I prepared with my colleagues David Jodrell and Seden Karakurt about evidence based programmes in the context of child protection. I thought it might be useful to blog that submission in full. Here it is.

Evidence Based Programmes in Child Protection

Much attention has been given in recent years to the place of evidence based programmes in children’s services. These are prevention, early intervention or treatments that are proven at a high standard of evidence to improve children’s health or development.

What counts as an ‘evidence based programme?’ For the purposes of this brief overview, the same standards of evidence applied in the Allen Review of Early Intervention have been adopted. These standards, developed by an international team of experts, are not written in stone. But they provide a ready tool to assess the variety of potentially evidence based programmes relevant to the task of protecting children from maltreatment.

This process selected programmes that were supported by at least two robust evaluations in which the effects on those receiving the intervention were compared to a control group. One of the evaluations for each programme included was a randomised controlled trial[1].

The search focused on prevention, early intervention and treatment programmes that have the potential to:

• reduce the risks of child maltreatment

• reduce maltreatment.

The list did not extend to programmes that reduced the effects of maltreatment, such as emotional and conduct disorders, or other mental health problems consequent upon maltreatment. (There are many examples of evidence based programmes in this category).

The following summary also drew on meta-analyses or systematic reviews that bring together many rigorous evaluations. The paper by Christopher Mikton and Alexander Butchart for the World Health Organization is an exemplar[2].

What types of evidence based programmes exist?

The following attached table summarises the types of programmes that exist, and whether there is evidence of impact on risks of maltreatment or the level of abuse.

*Intensive parenting programmes focused on child protection reduce maltreatment

1) Community/Public health strategies

Two programmes exemplify this category. Much attention has been given to the delivery of all five levels of the Triple-P parenting programme in South Carolina in the United States. This begins with media strategies to change parenting behaviour in the general population but also provides intensive group based training for parents of children who are known to child protection agencies. This strategy has produced significant reductions in abusive behaviour and referrals to child protection.

The Safe Environment for Every Kid programme better prepares people living in disadvantaged communities to identify and respond to child maltreatment, and to work more closely with public agencies such as social work.

2) Health visiting programmes

The class of evidenced based programme with the greatest impact on child maltreatment involve intensive and enduring work by health visitors with parents whose newborns are at most risk of poor outcomes. Family Nurse Partnership, being delivered in the UK with fidelity to 6,000, soon to rise to 12,000, vulnerable, mostly teenage lone mothers, has the strongest pedigree. Among a long list of benefits to child and mother is a reduction in reported child abuse and neglect of 48% by the time the child is 15 years old.

3) Early Years support

There has been relatively little attention given to the contribution played by early years provision, for example Sure Start Children’s Centres, to reducing child maltreatment. Evaluations of an early version of this approach, the Chicago Child Parent Center, report positive findings. For example, the lower incidence of child abuse leading to higher parental involvement in the child’s development explained about a quarter of the variance in reductions high school completion and juvenile arrest attributed to the CCPC programme.

4) Parenting programmes

There is good evidence that proven parenting programmes like Incredible Years and Triple-P, both widely applied in the UK, reduces the risks of maltreatment, and some evidence of reductions in actual maltreatment. The Triple-P universal programme, for example, applied in a community of 100,000 people would result in nearly 700 fewer child maltreatment cases, 240 fewer children coming into foster or residential care and 60 fewer injuries.

These generic parenting programmes are generally delivered to families with a child experiencing impairments to health or development, a conduct disorder for example. More specialised programmes, such as Parent-Child Interactive Therapy, have been delivered to families known to have abused their children, and with good results. For example, in a US evaluation, more than two years after intervention, less than a fifth of families in the child protection system receiving PCIT had been re-reported for maltreatment compared to nearly half receiving services as normal.

5) Therapeutic models

A wide range of therapeutic models have been evaluated and shown to have some impact on child abuse outcomes. For example, the Infant-parent Psychotherapy and Psycho-educational Parenting programmes have proven impact on attachment in families where the parent is known to have abused their child. Trauma-focused Cognitive Behaviour Therapy (CBT) has been used with some effect with children who have been badly maltreated.

What does not work?

The same high quality evaluations used to find out whether or not an intervention works can be used to indicate what does not work. That is to say, some programmes, designed with good intentions, result in negative effects, such as more children being abused or reported to child protection agencies.

Just as a positive evaluation does not imply a programme must be used, a negative finding does not indicate that a programme must be axed. The findings suggest a direction of travel or encourage further testing and exploration.

Generally speaking, there are less than promising results from interventions that focus on keeping together families where there is high risk of child maltreatment. (This is not to say that such efforts should cease, just that impacts on child maltreatment are, at best, likely to be mixed).

For example, Homebuilders, an intensive family preservation service delivered in several US states, produced impacts on child maltreatment and placement away from home that were initially promising but soon tailed off.

Family Group Conferences also deserve a mention in this category. There have been many studies of family group conferences, but only two that met the exacting standards applied by the Allen Review Team. These evaluations show, at best, mixed results but also evidence of iatrogenic effects on child abuse and maltreatment that correspond with the findings from intensive family preservation. Again, these results do not definitively say that Family Group Conferences are damaging. However, more reflection and evaluation is required.

The Problem with Evidence Based Programmes

Any rapid review of evidence based programmes runs the danger of selecting a short list of interventions and giving the impression that they have the potential to eradicate the problem in hand. Evidence based programmes are not a cure-all for child maltreatment or any other aspect of child development. The list of challenges is long, but a few points are sufficient to inject caution.

First, because other countries put a higher value on experimental evaluation methods in the context of children’s social needs, many of the proven models come from outside the UK. This does not invalidate them any more than Microsoft computers should be invalidated because they were invented in the US. But it does urge caution and re-testing to ensure that the ideas travel well. (Most partnerships doing this work in the UK are finding that, so far, the programmes do travel well).

Second, the relative absence of rigorous evaluation in the UK means that it is simply not known whether home-grown interventions are effective. It may be that UK boasts many more effective responses to child maltreatment than North America, Australasia or Scandinavia.

Third, if evidence based programmes are not delivered with fidelity, that is to say if they are not delivered as they were intended to be delivered, with the correct levels of training, coaching and adherence to the manuals, they seldom achieve their intended benefits. Moreover, a proven model can be damaging when delivered badly. Getting the right staff, to deliver the right programmes, to the right people in the right way has proven elusive for some UK agencies.

Fourth, there is a difference between proving an intervention in trial conditions and seeing the effects at scale with several tens of thousands of children. Most evidence based programmes have little market penetration. It is for this reason that results from interventions like Family Nurse Partnership that is reaching seven per cent of eligible children within three years of its introduction to the UK are attracting so much attention.

Fifth, mainstream systems, such as social care and the police, have little experience of delivering evidence based programmes, most of which depend on short-term, marginal funding. Getting systems ready for evidence based programmes and evidence based programmes ready for systems is fundamental to any progress in this area[3].

Evidence based programmes and child protection

Evidence based programmes will never be a panacea for problems of child maltreatment. As this brief review demonstrates, there are strategies known to reduce risks of child abuse but implementing those strategies is challenging. Moreover, supposing nothing was known to work, in the context of child abuse it would still be necessary to act.

It would, however, seem sensible for managers of resources to have more access to information about what works in the context of child maltreatment, much as argued by the Allen Review in the context of early intervention. This information would never tell managers or practitioners what to do. But it would be an important point of reference during the allocation of scarce resources.

Second, more could be done to test promising innovations in the UK to see if they deliver similar results to those rigorously evaluated in the US, Australasia, and Scandinavia. Many of the interventions referenced in the Munro Review, Re-claiming Social Work for example, would be expected to have child protection benefits and deserve to rigorous evaluation.

Third, where evidence based programmes are being implemented, there should be the proper attention to fidelity necessary to make them work.

[1] With the exception of Chicago Child Parent Centers, where a robust quasi-experimental design gives indications of impact of Children’s Centre type provision on child maltreatment outcomes.

[2] Mikton, C. & Butchart, A., ‘Child maltreatment prevention: a systematic review of reviews’, Bulletin of the World Health Organization, 2009, 87, 353-361

[3] See Little, M., Proof Positive, Demos, 2010 for full exposition of this challenge

 

*****

Orchid in the woods

Blog entry: April 1st, 2011

 

Every now and then, ambling through the woods of scientific orthodoxy that populate a conference like SRCD, one comes across a beautiful orchid. They are rare finds.
Jane Costello’s natural experiment to test the effect of higher family income on the mental health of children in the Smoky Mountain Longitudinal Study was a great example. It is many years old now, but it stays in the mind.


Jane’s colleague at Duke University Ken Dodge provided another on the first day of the SRCD Conference in Montreal, Canada today.


Dodge has been experimenting with a series of community wide interventions to reduce child maltreatment. I think of this kind of initiative as the future of child protection. The story in Prevention Action describes the details.


The orchid in the woods is the evaluation strategy used by Dodge and his colleagues. It is commonplace to have insufficient resource to provide every family with additional, largely unproven interventions. Faced with this problem, and looking for a fair way to proceed, Dodge got the communities in which his interventions would be tested to agree that babies born on birth dates with an even number would get extra help, while those born on a birth date with an odd number got services as usual.


Later, a team asks the parent of one child born on each day of the year to participate in a descriptive child development study. Of course, half will have been offered extra help, and half will not.


In this form of random allocation, the date becomes the identifying factor. One does not need a name. That means that in say 10, 20 or 30 years, if researchers or policy makers want to examine administrative data to find out if the extra help translates into better school outcomes, or less incarceration or delayed parenting, they need only know the birth date of the study participants. Not their names.


Beautiful.

 

******************

Graham Allen is a heavy man

Blog entry: January 17th, 2011

Many leaders of children’s services in the UK will glance at the Allen Review on Early Intervention published today and dismiss it as important but soft. They will be making a big mistake.
The Review is all about evidence based early intervention. It is about nipping problems in the bud and not waiting until they bloom in the gardens of child protection, youth justice, mental health and special education.

Children’s services and their employees are usually described with strong adjectives. Foster care and juvenile detention is about the heavy end. There is the hefty burden of responsibility on those who make the tough decisions about child maltreatment. There are the intractable problems of young people in trouble, in care or in need of treatment from mental health professionals.
Few people disagree with the idea of intervening early to stop these problems occurring in the first place. But that ‘soft’ work, engaging, some time in the future, with a much broader range of potentially needy children, it is argued, should not detract from the ‘hard’ job of responding to the very needy who are knocking on the doors of children’s services as we speak.
True? I do not think so. Every person with an interest in the future of children’s services will find the Allen Review directly relevant to their work. Let me give some indications about the weight of his recommendations.

Allen talks about giving every child the social and emotional bedrock for a healthy life. Motherhood and apple pie? More platitudes about emotions and minor misbehaviours?
As the report indicates, a social and emotional bedrock for children translates into fewer conduct and emotional disorders and better school performance. The PATHS early intervention curriculum for all primary school children in Birmingham has the potential to reduce conduct disorders by two per cent in the City. That means less demand for ‘heavy-end’ services. Since happier and better behaved pupils learn more, it also has the prospect of improving school performance by over ten percentage points.

Allen clearly brings out the economic potential of evidence based early intervention. Readers will rightly raise an eyebrow and question the veracity of the data. There have been many false claims in the last three decades. But the technology to predict costs and benefits of competing investment decisions is now arriving at the door of children’s services leaders. My organisation is delivering it, free of charge. Only the fool hardy will ignore it. Early intervention really can make you money. It will also improve the well-being of children into the bargain.

Many of the programmes that Allen recommends are targeted at the same families that child protection, social care and youth justice target. Family Nurse Partnership is directly relevant to the task of reducing child maltreatment by high risk often teenage mothers. When I talk to the parents of three and four year olds with conduct disorders attending the Incredible Years programme in Birmingham children’s centres I can feel their reduced anxiety and need for additional help. (I have also rigorously measured it). People watching the videos of parents and adolescents participating in Functional Family Therapy will see the clients that keep social workers and youth justice professionals awake at night.

So Graham Allen’s business -showing how evidence based early intervention programmes can reverse the down trend in child well-being in this country and make us some money along the way- is everybody’s business. It is not the soft end. It is the heavy end. It is child protection. It is mental health. It is about the young people we fail in foster and residential care. It is about students with special educational needs. And it is youth justice.

So people reading Allen’s Review may disagree with it. But they should not dismiss it as peripheral. It is core to the future of children’s services. And our children.

The first report of the review by Graham Allen MP into early intervention was published on the 19th of January. Michael Little is co-director of the Social Research Unit and contributed to the Review.

******************

Innovation Through Subtraction blog

Over the next few months, the Social Research Unit will be contributing ideas about how to get the best for children with less resources in a series of blogs. My contribution to the blog will be posted here, on the main page of my site.

To view all contributions to the blog, please visit the Social Research Unit website at: www.dartington.org.uk

   
 
Innovation through "subtraction"

Children’s services -health, education, social care, police and youth justice- are about to experience huge financial cut-backs. Some might argue the biggest cuts ever are upon us.

In the UK, with a general election almost upon us, there is a temptation to see the impending challenge in party political terms. That would be a mistake. What must be faced in the UK must be faced by all economically developed nations. We still live in a Keynesian world. Governments have been investing to stave off the worst effects of recession. Now we have to repay those investments.
 
There is a lot of fear. It is not just for the future of children it is also about jobs and livelihoods. As a small charitable foundation we feel the threat as much as any other children’s services organisation. There is no certainty we will continue to exist. But we also see many opportunities for children and for children’s services in the bleak economic outlook. Maybe it is going too far to say that the huge increase in spending over the last decade has injured child well-being.
 
But it is not unreasonable to suggest that spending less can be an effective route to better child health and development.
 
Over the next few months, the Social Research Unit will be contributing ideas about how to get the best for children with less resources in a series of blogs.
 
As befits a blog we do not wish to over anticipate the way the conversation will develop. But we know we have observations on the potential for better efficiency in local government. We will talk about how central government can help and not hinder.
 
We have ideas on the way in which smarter thinking about money can produce better child outcomes and will also suggest a series of experiments to achieve the same end. We will also consider what would happen if we were to design children’s service from scratch, unencumbered with the historical legacy of existing buildings, staff, laws and procedures.
 
The idea is to sponsor a debate about the opportunities that exist in these straightened times. And to support children’s services organisations looking to turn challenges into opportunities.

 
28th March, Liverpool

Half Marathon Day. I arrived with much anticipation. My mind was so jumbled my memory of what actually happened is blurred.

I have an idea that Haile Gebresallaise set off ahead of me with the proper runners. I think I saw Murakami twice. Once near the Anglican Cathedral sitting in a cafe having a nap, a half drunk cold beer on the table, a contented look on his face. Then again at the end, I am sure it was him, checking my time, not over impressed but giving a nod of approval, knowing I could have done worse and in future could do so much better.

It seemed highly unlikely but was that Zuckerman I saw as we entered Sefton Park? If it was it must have been Jamie Logan he was deep in conversation with, the young woman he abandoned in New York. He looked so much taller, more confident and assured than the impression he gives in Exit Ghost. She by contrast less so. She was as beautiful as Zuckerman described, but her impeccable sense of fashion was impeccably American not European and one sensed her sense of being out of place. I caught her eye as I ambled past. It was sufficient to make me want to stop but I was determined to take Zuckerman’s advice and resist all impulse. I wondered if she would be there at the end but I figured that pride was her metronome and sure enough I never saw her again.

The ghost in this story was Carver. As we gambolled around there was little mention of drink -one competitor talked about looking forward to ‘a full English and a pint’ at the end of the race- or tortured relationships -although there were a lot of men bellowing running tactics at their wives and girlfriends- and I saw only a couple of runners stop for a fag.

Smith was there, running with the abandon he perfected around the fields and woods of his Borstal. His resistance was to double back and repeat parts of the course so I think he must have passed me three or more times. Could it have been Narayan’s painter of signs that Smith bumped into as we negotiated the steps into Jericho Lane? It was a man on a bicycle with the tools of his trade for sure that caused Smith to spill from his pockets several iPods together with a dozen or so chips that monitor race times. For some reason the incident caused a lot of consternation among a group of Chinese students who had come to watch the race.

It was a tribute to the commitment of NHS doctors that the young registrar who on Friday gave me the all clear on three possible cancers made the journey all the way from Plymouth; at least I think it was him. It meant a lot to me. It’s true we became very intimate very early on in our relationship but even so I was impressed by his support.

Running produces a sort of dreaminess. Not a Richard Ford -Sportswriter, Independence Day- dreaminess that allows impulse to completely take over one’s life. A runner’s dreaminess is more positive. It is a sort of reverie in which imagination and thoughts come and go and clear the head of clutter.

Thinking back to the work of ChildHope and its partners brought me back to reality. A recurrent memory was a little girl, maybe six or seven years of age, who had come to my table as I drank coffee in the rural town of Debra Tabor in Ethiopia. I was sitting with Annania and Alemu, the founders of Chad-Et, and they started chatting with her. Her Dad had died. Her Mum had remarried but her Step-Dad didn’t want his new wife’s children. The girl and her younger brother were sent to relatives but they were beaten several times and so they made their escape. By the time she ran into us she was 40 kilometres away from home. They were headed to Addis, looking for work, begging along the way. Such is the road to sexual exploitation. But this girl struck lucky because she encountered two people who have given their lives to rescuing street children, intercepting them as they journey to Addis and now learning how to put in place supports and programmes to prevent them having to run away in the first place.

All of this took my mind away from the long hill past the Anglican Cathedral, diverted my attention from the doubling back around Sefton Park that brought into sharp relief the thousands of runners ahead of me, and compensated for the strong wind off the Irish Sea into which we ran for the last five kilometres. And shepherded me home in a time of two hours and eight seconds.

So all of my modest goals were met. 550 kilometres of training; done. Eight kilos of weight; lost. The Liverpool Half Marathon in a time better than Haile Gebresallaise can do a full marathon; done!

And thanks to many supporters about £2,000 to promote the important work of ChildHope and its partners. Not enough. But, as Murakami would say, better than nothing.

21.10km race (2 hours and 8 seconds)

 
23rd March, Seattle

So the training comes to an end. 550 kilometres. About 150 more than I had anticipated at the beginning, about 50 less than I was working towards prior to injury. It feels a little bit of an anti-climax, but the Seattle waterfront is a great place to round things off. And my taxi driver to the airport turns out to be Ethiopian and we talk about Chad-Et, the problems of early marriage of children, the coffee, the food, especially Dora Wat and Injeera, to the extent that we are both transported back to East Africa with all of its promise and problems.

45 minutes jogging (7.61km)

 
22nd March, Seattle

Five days to go. I am getting impatient.

30 minutes jogging (5.54km)

 
21st March, Seattle

Six days to the race. I am craving a cigar. A Cohiba Siglo VI or a Short Churchill would be perfect. They just don’t fit with this Murakami lifestyle I have been following. Wouldn’t really do for Carver either. He is more inclined to Camel un-tipped washed down with a bottle of Tanquerey. Maybe I could bring Carver up to date with a Sheesha pipe (equivalent they say to three packs of Camel’s)?

20 minutes jogging (3.61km)

 
20th March, Totnes

A week to go. Running makes one much more aware of the length of a routine journey whose distance one wouldn’t ordinarily calculate. I now know, for example, that it takes four minutes to run around the block. In an emergency I could be down the pub in a minute.

40 minutes jogging (7.24km)

 
19th March, London

A week to go before the urologists do some procedures on me, as the Americans put it, and just under a week until the race. I am having a crisis of confidence. What is all this running for? Why am I losing so much weight? I always aspired to be rotund. Like my departed friend Dave when he was young. Or Sydney Greenstreet in the Maltese Falcon. By God sir what a character he was. Clever, obsessive and immobile. That’s the person I aspire to be. Or strolling confidently along a mediterranean beach with a Pablo Picasso belly. Never mind the paintings, what a paunch. By now I am emaciated. I am moving in the wrong direction.

But cannot stop myself running around the Serpentine. A seven-minutes-past-normality-man swims in the lake past a film crew on the shore, all wrapped up warm, cupped hands around steaming coffee. Still no obvious symptoms. If I am dying my body has decided to keep the fact to itself.

35 minutes jogging (6.27km)

 
18th March, Dartington

My colleague Roger Bullock reminds me of the people we knew who started running at my age and died on the Marathon course. He has a taxonomy of untimely deaths. Popping off on the Marathon course indicates naivety. Expiring while making love to the younger woman you left your wife for is just deserts. Falling of your perch on the toilet is bad planning. He knows all the potential exit points.

A short but slightly more rigorous run. Still no symptoms.

30 minutes running (5.44km)
 

 
17th March, Dartington

As comfort from all the stress I pick up Raymond Carver’s What We Talk About When We Talk About Love (from which Murakami got the title for his memoir). Two couples talk about love. As bottles of Gin are slowly sunk the conversation submerges into abuse and pain; previous marriages marred by maltreatment and a car crash claiming young lives. The Gin draws out all that is bad in relationships. The reader gets a sober glimpse into an ordinary bad day for a couple of US couples. Its a long way from the wholesomeness of Murakami. Its an antidote for running! I begin to think about how to train for drinking hard liquor with a woman who no longer loves me.

A short and hilly jog around work to see how the body holds up. No obvious symptoms.

30 minutes gentle jogging (4.86km)


 
16th March, Dartington

The NHS is a great British institution. But it has its off days. My local surgery represents all that is good about primary health care but it didn’t show its best side today. I had imagined that peeing pure red blood would fast track me to the doctor’s door but I hadn’t banked on the small army of administrators in the slow lane. The local practice has adopted a sophisticated strategy of making appointments for sick people a week after they refer themselves, by which time presumably the majority are better or dead. I guess in time there will be people who try and cheat by anticipating sickness. Eventually an unwitting locum undermined the system and gave me an appointment. His advice was clear. Nothing to do with running. Go and see a urologist quick. It turns out that urologists -whose protective barrier of administrators includes a website, an unlicensed Rottweiler on the phone in Milton Keynes (trained to use the website) and a nice lady in Newton Abbot- takes the opposite tack to the surgery by giving lots of appointments on a single day in the near future. (This to honour the politicians’ commitment to reduce waiting times). Failure to accept the invitation is rewarded with a ‘Return to Go’ card and re-acquaintance with the local surgery administrators. The undertaker, by contrast, where some of these stories inevitably end, allows the customer to drop in at a time of their or their relatives leisure. 

By the time I set off for my run I had talked to six administrators, one doctor and a nurse. There seemed a reasonable chance that I was dying but not much prospect of seeing anybody who could tell me for sure. But running brings fortune. When I got back from an hour’s jogging I peed pure red once again. I called my seventh administrator at a social enterprise called Devon Doctors that provides out of hours healthcare advice. Having worked out that my condition was somewhere between terminal and attention seeking she got a doctor to call me. And guess what! He was a runner. And he had experienced the bloody pee! (Since he switched to cycling the symptoms had disappeared). His advice? Carry on running and make an appointment at my leisure with a urologist to rule out the sinister alternatives.

So that is the story about how I started and will continue to give blood on behalf of ChildHope and their partners working to improve the lives of children in Africa, Asia and South America.

60 minutes jogging (10.48km)


 
14th March, Torbay

Two hours running from harbour to harbour around Torbay. It is a beautiful clear day with a flat blue sea that, from very discreet angles, allows the moniker ‘English Riviera’ to ring true. I am expecting to polish off my second half-marathon but my running is laboured, and time runs out 200 meters before reaching the goal. Disappointment however is followed by excitement. A new and surprising injury -we hope. When I get home I pee blood. Among the glut of potentially life threatening maladies that fit the symptoms -kidney cancer, prostate cancer, bladder cancer, plus a wide variety of sexually transmitted diseases- I stumble on the possibility of ruptured blood vessels in the bladder due to the jarring motion of running. I take a Perrier bottle of brownish pee to the emergency doctor. His tests lead him to tell me to stop running for a few days until I can see my regular GP who will confirm a running injury or pop me in an ambulance to the nearest oncologist. 

120 minutes jogging (20.9km)

 
12th March, London

I make a rare foray to the television set to watch Eddie Izzard who is running 43 consecutive marathons. (He gets one day off per week). It puts me in mind of the world as a clock with most people pointing upwards to 12 noon. People like me, check-in at a minute past the hour, a little bit off beam. The nice ladies swimming in the Serpentine this morning were at least seven minutes past normality. And then there are the marathon nuts. The people not content to run 42 kilometres, they have to do that three times in one day, like Murakami, around Lake Saroma in Japan. Or those that pretend to be mountain goats and add a couple of almost vertical slopes to an already difficult course. These people we can put at a quarter after. Then there are the masters, such as Gebrselassie and Radcliffe, doing extraordinary things and making them look ordinary. With them it is already 12.20pm. But Izzard, he has gone almost full circle. He is at one minute to twelve. He is so out there he is almost normal again. His support crew includes an ice-cream van selling -on behalf of Comic Relief- Flake 99s. I heard him interviewed on Front Row on Radio 4 explaining that in nine to fourteen years time he would enter politics. Once again full circle. Entering politics in nine to fourteen years. How weird is that? It so weird as to be plausible and he will get my vote. In the TV programme one of the many people who found themselves, almost unwittingly, running alongside prospective candidate Izzard captured the mood of the nation by saying to him ‘Let me shake your hand because I think there's something wrong with you’.

(If you wish to donate five pounds to Izzard’s cause, text ‘eddie’ to 70005)

45 minutes jogging (8.07km)

 
10th March, Dartington

Thinking about Chillida in goal for Real Sociedad, I use my 90 minute run to conjure up a football team of great artists. Some positions are easier to fill than others. In addition to Chillida in goal, I have Giacometti as a gangly centre forward, Peter Crouch style. The ingenious temperamental Diego Rivera, despite his bulk surprisingly mobile, also plays up front. They are supplied on one wing by Frans Hals, sometimes in the team, sometime out, known for playing masterful football in quick bursts before drifting out of the game for long periods. On the other wing is the László Moholy-Nagy included on account of his wonderful name and being Hungarian. At the heart of the team are Klee -like Kaka known by his second name only- and Jacques-Louis David, each bringing in different ways precision to the midfield. The back four is made up full backs Lol Lowry (as he would be known in the Premiership) and Thomas Eakins. Rembrandt and Atkinson Grimshaw bring a gritty determination as centre-backs. 

The team is managed by Picasso who is gradually changing the way the game is played. But he has to deal with a flock of unhappy squad members who cannot get into the team, including midefielders Max Beckman, Franky Goya and Stuart Davis plus master technicians Hiroshige and Hokusai.

90 minutes jogging (15.67km)

 
11th March, Nottingham

It is remarkable how people’s sensibilities vary from place to place. The people in Nottingham are more friendly than most and use the word ‘duck’ as a term of endearment, which is very endearing to me. So running alongside the canal I pass several people who wave and say good morning including a woman in a bright pink top who shouts out to my matching hat, ‘lovely colour hat duck’. 

45 minutes jogging (8.29km)

 
8th March, Dartington

Outside of Spain I have taken to running in a Real Sociedad football shirt. This was very confusing for Ethiopian football fans who recognised that it was Spanish and potentially important but had never heard of Real Sociedad (top of the Spanish second division and still, as far as I know, the only football club to boast a world leading sculptor -Eduardo Chillida- as a former goalkeeper). In Spain, by chance, I wear their national colours, not necessarily the best choice in the Basque Country. But the locals stress the need to be tolerant of foreigners -los americanos to be precise. When I think I am getting the hang of running, in homage to my hero Haruki Murakami, I wear Mizuno top and shorts in restrained colours preferred by the Japanese. 

But for the race day! I shall be running in the colours of Ethiopia. A gift of ChildHope partners Chad-Et, and with their logo on the front. I am hoping to be the only runner in Ethiopian colours that day, spreading confusion and concern by my strangely slow speed and gait!

60 minutes jogging (10.51km)

 
7th March, Dartington

I Jog with my dietary expert friend Dorothy. She looks very dapper in a matching Gor-tex running top, running trousers -there must be a technical word for ‘running trousers'- and even a matching head-band. It puts me in mind of an article someone has dropped into my reading tray from the Journal of the Philosophy of Sport. It details Paula Radcliffe’s attention to detail as she became the world’s greatest woman marathon runner. She wears sunglasses to prevent the tension that is produced by squinting from getting into her body. She wears a strip on her nose to aid her breathing. (I am attracted to this partly because ex-Liverpool centre forward Robbie Fowler used to do the same). She wears knee-high compression socks to boost her blood circulation (not quite so tempting for me), and gloves to reduce the need for the heart to pump too much blood to her hands.

12.01km (68 minutes)

 
5th March, Dartington

It appears that the railways, British built, are the conduits down which street children wash onto the streets of Kolkata. Nilam was lured onto a train with biscuits. Rajesh ran away from his torturing grandfather to find his dad who worked as a tea hawker in New Japaiguri railway station, a search that took him on a journey around India that R.K. Narayan could not have imagined for one of his evocative novels. Pappu, nine years of age, decided to run away and make some money for his impoverished family, but ended up on an overnight train. He had no idea how to get back. Cina Asha somehow managed it, but the problem keeps reoccurring. His family is poor. And Pappu wants to help. All of these little snippets of extraordinary lives are offered absent the real horrors that the children endure.

37 minutes jogging from home to work (6.34km)

 
4th March, London

Nilam’s story brings out the challenges and successes of Cini Asha’s work. She was picked up at the police station. The only thing she could remember about her home was that it was in the Mathpukur neighbourhood in Kolkata. She had been playing outside her home when a man tempted her away with a packet of biscuits. Before she knew it she was on a train. She escaped but then had to fend for herself in Kolkata, the world’s eight largest City.

Cini Asha workers toured Mathpukur with Nilam trying to find her home but with no luck. As they moved around they left information about their work. By chance two people who knew of Nilam’s disappearance picked up the information and got in touch with Cini Asha. A week or so later she was re-united. A bonus has been the support Nilam’s father gives to Cini Asha, helping the rescue of other children who suffered the same misfortune as his own.

60 minutes jogging (10.52km)

 
3rd March, London

My running obsession means I take my eye of the ball of supporting ChildHope in its extraordinary work. While I splish-splosh along the foggy banks of the Exe Estuary ChildHope is supporting an organisation called Cini Asha to intervene with street children in Kolkata.

The early work started with the police, for it is they who are most likely to pick up kids on the streets. It turns out that police in Kolkata are a little like police in London or New York. A little sceptical at the outset but very smart and efficient once they are properly appraised of the situation. Cini Asha have been helping the police to understand why children are forced onto the street in the first place and to work out the best ways of getting them home, or at least to a better place.

As a result has engaged with almost 4,000 children over the last five years. A statistic that acts as a reminder about not only how much can be achieved but also about the size of the problem to be tackled. There are no hard and fast data but it is hard to imagine that Cini Asha’s work is doing anything more than scraping a thin layer off the top of a massive iceberg.

36 minutes jogging (6.63km around the Serpentine in Hyde Park, from which two women emerged in their swimming costumes unfazed by either the icy water or only slightly less chilly air.)

 
28th February, Exe Estuary

My first Half Marathon crept up on me almost unexpected. I had planned to run the following day but the weather forecast was poor. I had slept and eaten late but by three in the afternoon I ran out of reasons not to run. I set off to the Exe Estuary, a guaranteed flat route. There were no mountain goats, just deer in the grounds of Powderham Castle. It was wet underfoot so the swish-swish-swish of my arms in the wind was drowned out by splish-splish-splosh as I first failed to avoid big puddles and then abandoning attempts to stay dry ran right through them. Then it was squelch-squelch-squelch through the mud and the suck-suck-suck of a marsh I ran into by mistake. As the mist settled on the estuary I was more in mind of Magwitch and Pip in Great Expectations than Smith and the Governor in Loneliness. I expected to be slowed significantly by the conditions but I when I clicked off the iPod at two hours Joan Benoit-Samuelson congratulated me on my longest run so far, 21.2 kilometres, 100 metres more than a Half Marathon. I confess to not knowing Joan Benoit-Samuelson -the 1984 Olympic Gold Medalist for the Marathon in a time 25 minutes longer than I took for half the distance- but I am now counting her as a close friend.

Two hours of running and jogging (21.2km)

 
27th February, Totnes

Dog tired after an overnight flight from Denver I don’t have the strength to drive the 20 miles to register for the Billy-Goat Half Marathon, never mind get up at 8am the following morning to run the race. So I settled for a gentle jog along the banks of the river to keep the blood following until UK bedtime.

30 minutes jogging (5.45km)

 
25th February, Denver

I run alongside a creek that flows through downtown Denver and into a river. I pass several gathering spots for homeless people. And then, rather prophetically, a jumbo packet of biscuits abandoned, unopened, on a bench. Possibly by a mildly obese biscuit lover running away to start the diet?

45 minutes jogging (7.34km)

 
22nd February, Denver

My second round of training at altitude doesn’t come to much. Pressure of work means I manage just two short runs in the ‘Mile High City’. Maybe its the cold weather and snow on the ground but I seem to feel the lack of oxygen more than in Addis Ababa. The pressure on my lungs reminds me of my first dalliance with running about 15 months ago. I started with six, six minute chunks. Each chunk was broken down into three minutes jogging and three minutes walking, and then later four minutes jogging and two minutes walking and so on until after three months or so I could jog for 30 minutes or so without a sense of foreboding. These first forays were exhausting. I was gasping for air. And then slowly my body has adapted to the point where I can jog for more or less a couple of hours and, by my reckoning at least, at a reasonable pace.

The thin air takes about 10 per cent off my distances.

20 minutes jogging (3.38km)

 
21st February, San Sebastian

Can there be a nicer place to run than this? San Sebastian is hilly and surrounded by mountains -presently and unusually snow-capped. But I can run down the river and around the La Concha -the first bay- and Ondarreta -the second bay- and back around both before circling the sea-edge of Mount Urgull and Zurriola -the third bay- before retracing my steps down the river.

I am in the flow as the psychologist Czikszentmihalyi would say. Smith puts it better in Loneliness when he says:

‘I ran to a steady jog-trot rhythm, and soon it was so smooth that I forgot I was running, and I was hardly able to know that my legs were lifting and falling and my arms going in and out. Then I turned into a tongue of trees and bushes where …. I couldn’t see anybody, and I knew what the loneliness of the long distance runner running across the country felt like, realising that as far as I was concerned this feeling was the only honesty and realness in the world and I knowing it would be no different ever, no matter what I felt at odd times, and no matter what anybody else tried to tell me’.


I am brought back to reality by a caricature, an old man -in his late sixties maybe- with a Basque beret, a cigarette and a stick who turns to gasp at a man he would regard as old -in his early nineties perhaps- fully kitted out to sprint and who slowly jogs by in the opposite direction. Cigarette in hand the Basque beret breathless by what he has seen signals to me ‘did you see that!’


100 minutes jogging and running (17.27km)

 
20th February, San Sebastian

Loneliness of the Long Distance Runner is about resistance. Not like Roth resisting impulse. More of a class resistance. Standing against what one is supposed to do, what society wants one to do. Smith must decide whether or not to win the race for the Borstal Governor. He can win. And he can decide not to win.

The Governor has high hopes and talks with self regard about the possibility that Smith will become a professional runner to which the young man reflects:

‘it wasn’t until he’d said this and I’d heard it with my own flap-tabs that I realised it might be possible to do such a thing, run for money, trot for wages on piece work at a bob a puff a rising bit by bit to a guinea a gasp and retiring through old age at thirty-two because of lace curtain lungs, a football heart, and legs like varicose beanstalks’

Should he submit to this corruption of the solitary enjoyments of his hobby? Should I give into the impulse to try out the Half Marathon that wise mountain goats defy?

My wise friend Santi who knows about a balanced life counsels caution. One injury could have lasting consequences. We talk about napping -one of Murakami’s secrets of a good life- and I relax a little. But back on the road I find I have Half Marathon anxiety and run too fast. Hence the star against the entry for Valentine’s Day. I surge ahead and then out of steam, and have to complete the last 15 minutes in the evening. My first cheat since Ethiopia. Today’s 20 minutes marks a return to normal levels of running neurosis.

20 minutes jogging (3.54km)
 

 
19th February, San Sebastian

Just before I left for Spain I met another proper runner, the Chief Executive of our neighbouring charity, and we had one of those incredulous ‘is it possible to run that slow?’ and ‘is it possible to run that fast?’ exchanges.

In 10 days time the first bit of my training programme comes to an end with a practice Half Marathon. For some reason I cannot quite fathom I share this secret with the proper runner -I wasn’t even intending to share it with you dear reader. To my horror he suggests I participate in a real Half Marathon that happens to fall on the day of my practice Half Marathon.

When I check out the details on the web I realise my obsession with running is in its very early stages. Mania beckons. There are two maps of the course. One is traditional and shows a loop around the beautiful Devon coast. How lovely! The other gives the ground elevation. It’s a route for mountain goats. In fact mountain goats would surely object the course for being too hilly. Come to think of it, ever seen a mountain goat running? There is a reason.

40 minutes jogging (7.13 km)

 
18th February, San Sebastian

In Nottingham recently I met a real runner. We had an exchange that has become familiar to me. (Running being my only topic of conversation these days I meet more than my fair share of proper runners). They tend to ask me what time I expect to do for the Half Marathon and when I tell them -just under 2 hours and four minutes- they give me a quizzical look. A little later I ask them how long it takes them to run a full Marathon and they say something along the lines of two hours and 45 minutes and I return the puzzled face. ‘How is this possible?’ we are thinking.

Over hearing this chat a Nottingham colleague Candida Brudenell is suitably unimpressed by Murakami and reminds me of Nottingham’s own runner-philosopher; Smith in Alan Sillitoe’s Loneliness of the Long Distance Runner. It is extremely funny, especially the scene where the money that cock-sure Smith has stolen appears before the policeman he is irritating as if manna from heaven. It is this that brings about his spell in Borstal -a Detention and Training Centre we would say now- where he becomes a runner.

Sillitoe has the evocative Nottingham dialect -curiously overlooked these days- to a ‘T’. And his running vocabulary is so rich. ‘Puff-puff-puff. Trot-trot-trot. Slap-slap-slap go my feet on the hard soil. Swish-swish-swish as my arms and side catch the bare branches of a bush,’ says Smith.

90 minutes jogging and running (15.87km) with a 10 minute walk in the middle

 
17th of Februrary San Sebastian

The descriptions of programmes by ChildHope’s partners in South America never quite capture the horror of life on a rubbish tip. This I observed five years ago in Recife, Brazil. I went as a favour to the Swiss based Oak Foundation to assess support needed to boost the work of an NGO working with street children.

The tip was in some ways a miracle of recycling. But that was the only redeeming feature. I would defy even the stoniest hearted of commentators like Maskalyk and Doctorow to describe life there without a good dose of emotion and shame. Filth. Stunted growth. Absence of light in the night-time. Constant risk of violence. Lack of adequate shelter, sanitation or any form of health care. Who can conjure a happy ending out of that?

I clung to some hope for a young girl who we gave a ride to college. The NGO had befriended her, gave her access to school and a place to wash, and she had secured a place on the exam roster. She talked about being a travel agent and was fascinated by descriptions of Europe, the places she had seen in books, as distant no doubt to her as her garbage pile home was to me.

In Peru ChildHope works with Centro Proceso Social and Amhauta in mirror like contexts. It is as hand to mouth for the NGO’s as it is for the people they support. For every one child they propel into a life even approaching normality there will be dozens if not tens of dozens they have to overlook.

To me it seems almost impossible for us in the cosy North to properly connect with these harsh realities. We make our donations and expect miracles. But in Brazil, or in Peru, or in the many other countries in which ChildHope operates the reality is endless hard decisions and squeezing every last drop out of our meagre offerings.

25 minutes jogging (4.59km) and five minute walk

 
16th February, San Sebastian

A couple of articles in the London Review of Books get me thinking about stony hearted assessments of what needs to be done and what can be done by organisations like ChildHope and its partners trying to protect children from exploitation.

Matthew Reynolds considers the work of E.L. Doctorow whose Ragtime I have just finished. Apparently Doctorow wrote it as a technical exercise to gauge his ability to capture a sense of restlessness. This he certainly achieves. The book reminds me of a Wes Anderson movie, like the The Royal Tenenbaums, in which dysfunction is routine, unremarkable and survivable. Like Anderson, Doctorow refuses ordinary feelings about individual and collective abuses.

Michela Wrong, correspondent for Reuters and Financial Times, reviews James Maskalyk’s, Six Months in Sudan, and comments on the dispassionate assessments that doctors are forced into when operating under duress. She reflects on Maskalyk, a Canadian medic volunteering via Medicin Sans Frontiers in Sudan, giving up on a child needing constant attention because, as he puts it, ‘at some point we went home to feed ourselves’.


Jogging for 30 minutes (5.23km)


 
14th February, San Sebastian

The result of no biscuits, crappy chocolate bars, one pudding per week and responsible alcohol consumption over 20 weeks is!?

About eight bags of sugar. EIght kilos. Seventeen and a half pounds in old money. About a stone and a quarter.

That should be the end of the story. The No Biscuit Diet is vindicated. But there is another claim, yet to be corroborated. 

The No Biscuit Diet only need be applied once. It involves giving up something unsatisfying for ever. And the result should be permanent change.

Will this happen? Will I be back to digestive munching ways in a few months? Swilled down with regular vats of coloured meths and topped up by a daily Kit-Kat? I hope not but we shall see. This blog will end with the Liverpool Half Marathon in a few weeks. But six or nine months or a year or so from now I shall provide a short addendum giving the evidence on long term change.

In the meantime I am awaiting an avalanche of offers from publishers for The No Biscuit Diet (all proceeds to ChildHope). It may be short but its probably effective. What better recommendation could a publishing house want? There will be resistance from the biscuit and coloured meths producers. But I can take the heat.

In keeping with my hero Haruki Murakami who named his first bestseller after a Beatles song I am thinking about catchy and timeless titles. So far Happiness is a Small Bum is looking the most promising.

Jogging and running 90 minutes* (16.46km)

 
13th February, Torbay

The No Biscuit Diet Deluxe: The Diet for Impatient Mildly Obese Biscuit Lovers

I spend part of my professional life showing people how changes in the lives of ordinary people improve not only their lives but also those of the extraordinary with significant problems. Alcohol is one way to illustrate the potential.

Over my lifetime alcohol consumption has steadily increased. When I grew up I never saw wine at home. My children, by contrast, must wonder if they are growing up in a vineyard. And not only are ordinary people like me drinking more, we also have more alcoholics in society. This is not a coincidence.

One solution is to get people like me and you, ordinary drinkers, to consume less. When we do that, for reasons I needn’t go into here, over time we get less alcoholics in our society. It can work in other contexts. If you don’t fancy hugging a hoodie you can reduce aggression by the few by being stricter with your own kids (so long as everyone else is doing the same for the many).

I was happy to tell everyone else about the benefits of drinking less but it never crossed my mind to take my own advice. Until the question of weight came up. Alcohol contains a lot of calories.

The potential of drinking less was made easier by the fact that most wine served in most UK bars is undrinkable. It is coloured meths. Sometimes they don’t even bother with the colour. And these days wine is served in small vats instead of a glass. Don’t get me started. I can feel another blog coming on. The Things I Write About When I Write About The Bloody Awful Quality and Dosage of Wine in UK Bars.

But back to The No Biscuit DIet Deluxe. My idea was to drink smaller amounts of drinkable alcohol instead of large amounts of undrinkable alcohol. So I replaced 21 ordinary UK bar glasses of wine with the amount recommended by the Chief Medical Officer, which is 21 ‘units’ of wine.

The word ‘unit’ is the key here. A small glass of Rioja is 1.65 units. A small vat of meth like wine in a UK bar comes in at 3.25 units. A couple of bottles a wine adds up to the weekly quota of 21 units. Or nine small glasses plus two pints of beer, if that is what takes your fancy.

That simple switch saves me another 1,000 or so calories per week, depending on whether it is wine or beer or spirits I include in my quota of 21. So when combined with the 1,100 calories from the biscuits, chocolate and pudding, losing six kilos became manageable in 20 weeks. 

As compensation I began to drink just wine that would be acceptable to a Spaniard, or French person or Italian. (Which practically rules out most bars in my home town of Totnes).

So I started to cut back on the biscuits, chocolates and desserts in September. And at the same time introduced the deluxe -less of better wine- component.

Has it worked? In November I was heading in the right direction. But I had not shed those six bags of sugar. Tomorrow I will have access to weighing scales when I visit San Sebastian. Twenty weeks on from the start of the No Biscuit DIet I will find out if the regime works.

105 minutes running and jogging (18.67km)

 
11th February, London

The No Biscuit Diet: The Diet for Mildly Obese Biscuit Lovers

The No Biscuit Diet is one way for slightly over-weight people to lose a few kilos, permanently. 

‘Biscuit’ in the No Biscuit Diet is a metaphor for food that at first excites but ultimately disappoints. Think of the things you have consumed and then thought ‘why did I eat that?’

Digestive biscuits are an exemplar. Low grade chocolate bars fit the description very well. Puddings in second rate restaurants. (How many times is it necessary to try a crème brûlée to find out that most UK and too many US chefs cannot master even the simplest of tasks).

There are some ingenious culinary adaptations based on this idea. For example, in the Spanish autonomous region of Pais Vasco it is possible to order a zurito, a wine glass of draft beer. Why? Because the first taste of beer, like the first bite of a pizza, is wonderful. But the last sip of a long glass of beer or the last mouthful of a big pizza is generally unsatisfying, producing a longing for more. Small amounts that leave us content are better than large amounts that produce discontent.

The diet involves setting your own goals. Every 3,500 unconsumed calories translates into about half a kilo in weight loss.

So I gave up biscuits. I banked on eating five digestives a week; on a bad day I could manage that in an afternoon. That saved me 350 calories per week.

I gave up crappy chocolate bars. I used to eat about one Mars bar and one Kit-Kat each week, usually in the evening with the kids or as a remedy for mild suicidal ideation consequent on being a prisoner on a delayed train. That saved me 500 calories per week.

And I restricted myself to one dessert in a restaurant per week, instead of at least two I had been subjecting myself to. That saved me another 250 calories per week.

So that came to 1,100 calories a week. Meaning it would take about 38 weeks to deposit the six bags of sugar I would otherwise have to cart around the Liverpool Half Marathon course.

A little bit slow? Tomorrow I offer a remedy for those seeking a quick fix. 

30 minutes jogging (5.42km)


 
10th of February, London

When I started this running lark I was 76 kilos. That translates into a BMI of 25.2 making me, like most men of my age, mildly obese. By losing six kilos my BMI would fall to 23.3 making me, like most men of my age in the last generation, about the weight I should be.

I wasn’t much fussed about being like men in the previous generation. But the idea of not lugging around six bags of sugar on my Half Marathon was quite appealing. But I have never been on a diet. I tend to think of diets as a tool for people who want to lose weight and then put it back on again, and then lose it again and so on. I didn’t fancy dieting as a hobby.

You might imagine that all the training would translate into less weight. It helps but it is not in itself an answer. According to my iPod, five kilometres of jogging is equivalent to about 350 calories. That's about the same as four chocolate digestive biscuits. It takes half an hour to run five kilometres whereas the digestives are gone in no time.

Added to this frightening lack of equivalence is the tendency to want to replenish the energy one has lost from jogging. Not immediately afterwards. But as the day wears on so does the desire to top up.

So with some debt to my dietary expert friend Dorothy, who was extremely generous despite the spectacular failure of her No Dessert Diet, I devised a plan that may or may not come to fruition this week.

85 minutes jogging and running (14.97km)

 
8th of February, Dartington

One goal has been to train properly. Hence the 450 kilometres of conditioning. (Despite Tiger Woods’s proclamation, I reckon I am just 250 kilometres towards my target). The main objective is to enjoy running the race in the same time Haile Gebrselassie needs for a full marathon. Concomitant with these designs has been to start the race six kilos lighter than when I agreed to participate.

This last ambition may be about to be realised. Or not. My only access to weighing scales is in an apartment I use in San Sebastian in Basque Spain. I have not been there since November. But in six days time I will be back.

55 minutes jogging and running (9.5km) plus five minute walk

 
7th of February, Dartington

I wake earlier and earlier anxious to get running. It helps that the days are getting longer. The last day of this week will be 30 minutes longer than the first. I wake from dreams borne of obsession with running. Earlier in the week I passed a child and his mother watching a buzzard regal on its tree perch. In my sleep the buzzard becomes a leopard, hugely exaggerated in size, attended by a couple of pigeons. I drift into Upper Parliament Street in Liverpool and am passed by a chipper Harry Houdini. According to Doctorow in Ragtime the great escapologist felt unloved in the US and came to Europe for true acclamation. He appeared at the Liverpool Empire 106 years and a week ago this week, and his name is still synonymous with extraordinary sidestep. And he potters around in my mind as I try and rest.

80 minutes jogging (13.77km)

 
5th of February, London

One of my interests in ChildHope’s work is to find out what is happening in what we used to call the Developing World and we now call the Global South that could help children in Europe or the United States. As I run under the long Park Lane underpass I get into a echoey conversation with a young homeless man. He asks me how far I am going and after considering my reply tells me I am an idiot. I am wondering whether I would be more likely to invest in him if he were a customer of the CDK Bank? All the same ethical questions arise. But my current salve for the conscience produced by homelessness, regular contributions to the poor box in Farm Street Church, is no less problematic.

45 minutes jogging, (7.93km)

 
4th of February, Dartington

One would imagine it is relatively straightforward to help children in dire need. But ChildHope’s work produces many ethical dilemmas.

The successful partnership with Children’s Development Khazana or CDK is a case in point. How do children who work for a living manage their money? They live by their wits. They often have no relatives who can mind their takings. Sometimes they have no home, and even if they do, no safe place to store money.

This pushes working children towards spending as quickly as they earn. It encourages instant gratification. It handicaps their ability to get out of the hole. And in some cases, say when earnings are spent on drugs, the money can deepen the hole.

CDK provide a banking service. The bank is owned by its clients. Its a ‘mutual’ or an old fashioned building society or a credit union.

There are 14,000 customers and several hundred volunteers supporting the Bal Vikas Bank as it is known in India or Butterflies as it is known elsewhere in South Asia. There are 75 main branches and 49 sub-branches, extending to Afghanistan, Bangladesh, Nepal and Sri Lanka as well as India.

Not only can children save at the Bank, they can get advances to start up small businesses.

CDK and ChildHope are providing a valuable service for working children. But by providing this service are they encouraging children to work? ChildHope must constantly reflect on this and other ethical challenges. Ceasing to support the expansion of the bank will not stem the flow of children into work. But helping working children to save may well be the spring for a better life.

60 minutes jogging (10.32km) plus 5 minute walk

 
2nd of February, Dartington

If we see the Global South through the looking glass of television appeals -the simple touch of a celebrity bringing a smile to the face of sad but good children- we can think of it as a fable full of threats but with a happy ending. The reality is not like that. It is much much more miserable. And threatening. Plus all this misery and threat is normal. It’s part of life. 

In a regular review of programmes at ChildHope our colleague Allan Kiwanuka reports on his work in Uganda. 

ChildHope is working with two organisations in Uganda -the Reproductive Health Bureau and the Youth Anti AIDS Association- to help children affected by the AIDS epidemic. The work has been going well in urban areas and now there is an interest in extending it to 15 remote islands.

The goal is to reduce the HIV rate. The virus has reached a quarter of the population, four times more people than the national average.

The islands are remote. Men, who are paid cash daily and mix a risky lifestyle with their risky work of fishing, come and go depending on their economic needs. These men are not committed to their communities and there are more of them than women. So child sexual abuse is not uncommon. There is hardly any public health infrastructure to respond to victims of maltreatment or those infected by HIV.

There is nothing chocolate-box-like about this vista. It’s like the wild West. And in the wild West children’s rights get short shrift. Alan’s descriptions of the remote Ugandan islands chime with E.L. Doctorow’s of New York a century ago. In Ragtime Doctorow writes:

“Children suffered no discriminatory treatment. They did not complain as adults tended to do. Employers liked to think of them as happy elves. If there was a problem about employing children it had to do only with their endurance. They were more agile than adults but they tended in the latter hours of the day to lose a degree of efficiency. In the canneries and mills these were the hours they were most likely to lose their fingers or have their hands mangled or their legs crushed; they had to be counselled to stay alert. In the mines they worked as sorters of coal and sometimes were smothered in the coal chutes; they were warned to keep their wits about them”.

As in Ethiopia and as it was in New York, the challenge in Uganda is changing the way people live their lives. ChildHope’s proposed work seeks to reach 90,000 fisher folk, giving them information about health and child protection and testing plus counselling for HIV. This will coincide with better health services and support for victims, of rape for example . The proposed work with 2,400 children, half in school and half out, will begin to break the cycle of maltreatment that has become engrained in island life. It will give children the chance to be children, as in modern day New York, and hopefully before another century has passed.

Two runs today -to compensate for work keeping me off the road tomorrow. Once in the dark early morning and once in the dark late evening.

40 minutes jogging (6.87km)

30 minutes jogging (5.27km)

 
1st of February, Totnes

At the end of my run yesterday I hear Lance Armstrong say something on my iPod but I cannot quite catch it all. (Lance is busy with many other runners so I cannot ask him to repeat). But it includes the Americanism ‘way to go’ so I assume its positive. But then this morning Tiger Woods shows up. Tiger! On my iPod. A man so busy in so many ways but with time to tell me -mistakenly I think, but not that I care- that I have just clocked up 250 miles.

20 minutes jogging (3.4km)


 
31st January, Totnes

I am about half way through the training regime. I have covered about 200 kilometres so far, about two and a half times my usual ration. I am edging towards the threshold that Murakami calls ‘serious running’ -about 150 miles per month- but still someway off what he would call ‘rigorous running’ -about 200 miles per month. Murakami is about 10 years older than me, but he is faster. And he can write whereas I cannot. To what extent can I close the gap?

Pondering this question my mind turns to another current hero Haile Gebrselassie. I differ from Gebrselassie is two ways. He runs twice as fast as I do over twice the distance. And he gets quicker as the race nears the end, whereas I get slower. 

On the plus side I am beginning to get the hang of the difference between jogging and running. The training regime has different combinations of the two, so this morning I jogged for 10 minutes, ran for 10, jogged for 20 minutes, ran for 10 and so on until I got to an hour and fifty minutes on the road. It was icy and the two days I spent drinking and eating too much did not help but nonetheless I find I can now slow myself down on the jogging sections, and speed myself up on the running sections. Before I got this idea I just set off at what seemed a reasonable pace and gradually slowed thereafter.

So what can I hope to achieve for this Half Marathon? I am going to try to get around the circuit in the same time Haile Gebrselassie would do a full marathon, two hours and three minutes (and 59 seconds). And like Haile I will vary my pace throughout the race. This way I can imagine crossing the finishing line with Gebrselassie (no matter that he will have been twice round the circuit to my one), Haruki Murakami will be able to say ‘not bad.’ Not good either, but not bad.

So the revised goals are: to complete the Half Marathon, within 2 hours and four minutes, varying my speed throughout the race. Plus, as Murakami demands, to have fun along the way.

110 minutes running and jogging (17.6km) plus 5 minute walking

 

.


 
28th January, Dartington

As I run along the edge of the Dartington estate my colleague Julian pulls alongside me on his bike and says ‘do you want a ride, I won’t tell anyone’. I let him go but my mind turns to marathon scams of the ages. Earlier this month, almost a third of the runners were disqualified for cheating in the Xiamen Marathon in China. The variety of hustling was impressive. Some jumped into cars for part of the journey. The techies gave their microchips -that record the passing of the start and finish line- to faster friends. Nobody went as far as Rosie Ruiz who won the Boston Marathon in 1980 largely thanks to riding the subway for most the way. Or Fred Lorz who took the Gold Medal in the 1904 St Louis Olympics in a time that would have impressed Haile Gebrselassie. The secret of his speed? Eleven miles in his manager's car. Haruki Murakami reminds us that running should be fun. But for the Chinese runners a quick time, however achieved, eased entry into university. 

All this skulduggery is diverting and I run my fastest 10,000 meters yet.

60 minutes jogging and running (10.42km).

 
26th January, London

Murakami writes about the benefits of solitude and the mind mastering the frail body. In the first few pages he reveals one of his mantras, to be repeated throughout a run, ‘Pain is inevitable. Suffering is optional.’ Carver on the other hand writes about the frail mind propped up by an abused long suffering body. It crosses my mind that were I reading Carver I could be in training for drinking bourbon with a woman who no longer loves me. As I get up at six on a cold London morning the Carver training regime seems more appetising than Murakami.

50 minutes jogging and running (8.5km)


 
25th January, London

On leaving university, Murakami opened a jazz club and adopted a lifestyle of late nights plus plenty of cigarettes and alcohol. In his early 30s he gave up the Jazz club to start a writing career. Running was a way of giving up smoking (smoking and running being incompatible hobbies) and adapting to the disciplines of penmanship. He ran his first Marathon in 1982, and continued at about one a year ever since, about the same rate as he produced novels such as Norwegian Wood. But in 2007 he wrote a memoir What I Talk About When I Talk ABout Running. Its a play on the words of the title of a famous short story by American writer Raymond Carver, What We Talk About When We Talk About Love. 

60 minutes jogging (9.75km)

 
24th January, Dartington

The facts keep getting in the way of my attempts to place mind over matter. Reading Philip Roth’s Exit Ghost his now 72 year old protagonist Nathan Zuckerman is unable to a seduce a 30 year old woman and knows that even if he succeeded he would be incapable of sex. He likens the disappointment to that of having run 10 miles. But in fact the effect of running 10 miles -the elation on having completed the run and the sense of energy that endures for several hours afterwards- is somewhat adjacent to the feeling of having succeeded in the seduction, not failed. Or when my knee complains as loud as a 72 year old knee I reckon that my mind’s ability to convince my body to run 19.5 kilometres might extend to convincing my aching joint to respond to a smelly potion that combines ginger, eucalyptus, clove, lavender and menthol. This witchcraft is called Jointace, a gel sold by one of the many sorcery shops in my home town of Totnes.  But looking on the web I find that its active ingredient is Glucosamine Chondrotin which, according to the esteemed National Institutes of Health in the US, is a proven remedy for osteoarthritis. Now I just need to convince my knee that it is suffering from osteoarthritis, which, by the time I am 72, shouldn’t be a problem.

Time to turn to the master of mind over the running body, Haruki Murakami, Japanese novelist and author of the memoir What I Talk About When I Talk ABout Running, after which this blog is named.

25 minutes jogging (4.26km) plus 5 minute walking.

 
23rd January, Dartington

In The Painter of Signs R.K. Narayan talks about Gandi encouraging his followers to look at their toes, so as to encourage self-reflection in a social country. It seems having come back from social Africa that the English have taken the Mahatma’s advice to heart. Early in the morning the streets are empty where in Ethiopia they are quickly filling. And those few souls around are surveying the ground where in Africa they were giving me, and others, intense inspection. I say good morning to one man but he is deaf and doesn’t hear me; but as I pass he looks up, see’s me and shouts out ‘good morning young man!’ (obviously short of sight as well as deaf) and then when I properly into his focus he adds ‘oh, and wearing shorts too!’. But he is one of the few eschewing the Gandi doctrine. 

But Lance Armstrong, via my iPod, is very impressed. ‘Congratulations, your longest run so far’ he tells me. 

2 hours running and jogging (19.5km) plus 5 minute walk

 
20th January, Nazret, Ethiopia

The coverage of the Haiti earthquake continues on the televisions in hotels foyers. There is no more to say than there was at the beginning so CNN is reduced to a  story about how long it takes for an aid package from ‘the small English town of Cornwall’ to the disaster zone in Port-au-Prince. 

In a major crisis like the Haiti earthquake government aid and the big charities come into their own. But routine problems like poverty, HIV, child prostitution demand a local response. Tapping into existing local, natural processes is often one of the most effective ways of responding to individual needs. One of Chad-Et’s projects, using US funds (USAID), does just that. 

Respect for the dead is important in Ethiopian society. When people began to migrate to the cities and had fewer social supports on which to draw they established Idirs. Historically the Idirs collected small amounts of money for the purposes of paying for a decent funeral. Nearly everyone contributes. Our colleagues on this trip were paying about five or ten Birr or 25 or 50 pence per month to their local Idir. 

Chad-Et and other organisations began to ask the Idirs ‘why not work to help people before they die, as well as afterwards?’ So Idirs started to collect for carriers of the HIV virus and AIDS orphans and to support other needy children, providing for example school materials. The US donations supplement this capacity which consequently goes much further than had funds been mediated by one of the big international charities or been given directly to one of the thousands of small non-governmental organisations established to meet the myriad of competing challenges to healthy child development in such a poor country.

Back in the back streets of Nazret, early morning, the children are walking to school dressed in uniforms that if new would not disgrace a 1950’s English Boarding school. One small boy, maybe six or seven years of age, runs alongside me, effortlessly. He is quite serious at first but when we exchange smiles he asks me, in English, for my name. I tell him and he repeats it back to me. He knows it because it is shared by one of his saints, and today is St Michael’s day -which coincides with the day Emperor Haile Sellassie returned from exile in 1941. I ask him his name and he tells me clearly but I cannot catch it. I tell him he runs well, like Haile Gebrselassie, and he conjures the possibility. At the end of the road he tells me in clear English ‘you go left here’ and he turns right for school.

70 minutes jogging and running (11.48km) with unscheduled five minute break for a walk in the middle. 

 
19th January, Matahara, Ethiopia

We are surrounded by real poverty discussing how to alleviate terrible abuses of children. But it would be a mistake to see life in Ethiopia only in these terms. There are so many good things. Its a cliche to mention the people -who no doubt are like people the world over- but I am nonetheless stuck by their warmth, generosity and confidence (it is a matter of pride to Ethiopian’s that they were never colonised and twice saw off the hapless Italians). The food is fantastic, although, in a country of hunger, we are fed too much. Crime is apparently non-existent. Over-relaxed, I leave my belongings -passport, money, camera, phone- here and there but they never disappear.

It should be a Mecca for tourists. There are several World Heritage sites including the Simien mountains (think Grand Canyon without Las Vegas), Lalibela (think Jerusalem cut into the ground) and Axum (second home to the Ark of the Covenant) and much more besides.

 

But a big draw for me is coffee. Ethiopia is one of a small number of countries -UK and US not included- where coffee making skills are embedded into the culture. People expect and know how to judge a good cup of coffee. 

 

The pinnacle for me is to be found in Cafe Tadelech in Matahara, a small town on the main road from Addis Ababa to Djibouti. We tested several to ensure -to use the technical term- fidelity to the model.

 

For the first time in the training programme I wake relieved I don’t have to run. I have developed an addiction for jogging but this morning I am temporarily cured.


 
18th January, Nazret Ethiopia

Providing a way of out of prostitution in Addis Ababa or intercepting children in rural Amhara making their way towards this way of life is an important service. But what about addressing the causes of the problem? My colleague Catherine Kirodotakou from ChildHope likens Chad-Et’s work to dealing with a leaky tap. They do their best to mop up the pool of water that hits the ground. Now they plan to catch and return to source some of the spray before it gets to the bottom. But what about fixing the tap so that no water escapes? What is causing all these children, some as young as 10, 11 and 12 years of age, to leave home and expose themselves to such dreadful risks?

The research undertaken by Dr Gebre Ayere identified several candidates. One was early marriage. It is the custom for many families in Amhara to marry their children at 12 or 13 years of age. Many successful marriages have been been borne of this custom. By chance I am reading R.K. Narayan’s funny and evocative The Painter of Signs which has a chapter on how ordinary such an arrangement was in 1970’s India. So it is today in Amhara region of Ethiopia.

 

The problem occurs when the child does not accept the arrangement. The only escape is to run away. Once they find employment the child may seek rapprochement by sending money home. If they are in the sex industry the remittances are larger but the family becomes dependent and the child is trapped.

 

So Chad-Et with ChildHope’s support is beginning to implement a prevention programme that will change attitudes towards early marriage and make people aware of the risks to children migrating unaccompanied by adults to local towns and the capital. They will be using the church and mosques, which hold great sway over public opinion. They are forming girl’s clubs in schools to help educate and inform. They employ a method called ‘community conversations’ that has proved successful in raising awareness about HIV to do the same for child marriage; the method brings together local leaders and gets them to discuss and find new solutions to major social problems (there may be much we can learn from this approach in the prosperous North).

 

The law in Ethiopia sets the minimum age of matrimony at 18 years. Chad-Et is trying to change public opinion so that the law is obeyed. Rather unusually they are going to rigorously evaluate progress and find out if they succeed. If they get it right thousands upon thousands of children may escape the risks of sexual exploitation.

 

I run and jog through the backstreets of Nazret (Nazareth). Many young boys wearing UK soccer premiership shirts shout ‘excellent’ as I pass. (Two days later exhausted by late nights celebrating Timkat or Epiphany my efforts beget more calls of ‘good’ with an extended ‘oo’ than ‘excellent’ with extended ‘e’s. The infants, with less reason to be polite, scream with laughter). The City is poor but every now and then I look down a side-street and its like a Robert’s painting of the other Nazareth, the sunrise bringing out the beauty and dampening the misery. I start at six but by seven thirty it is hot and busy and the air is thick with gasoline and for the first time in this training programme my brain fails to resist the impulse that my body is running out of steam and I stop early. I do the last 25 minutes of jogging in the evening, but every metre I am wishing I had got it over and done with in the morning.

 

100 minutes jogging and running (15.81km) plus 10 minutes walking.


 
16th January, Nazret Ethiopia

Over the decade of its existence, Chad-Et has helped several hundred children out of prostitution and into schooling or ordinary work. But for each child that they rescue another appeared to take its place. The next challenge for Annania, Alemu and Chad-Et was to stem the flow. 

They knew from talking to the girls that most were coming from the rural areas. They commissioned research from Dr Gebre Ayere who works at Addis Ababa University that gave some clues about the causes of the phenomena.

It appeared that a high proportion of the girls were coming from rural Amhara in the North of the Country. They were leaving home and school and heading for small towns on the way to the capital. They went into domestic service and other low paid employment. Often they were badly treated and they would again run away. Some were abducted but most hopped from badly paid job to badly paid job, and from town to town, until they reached Addis where they were sucked into the sex industry.

These data gave Chad-Et an opportunity to intervene early before the girls reached the capital. With the help of ChildHope and funds from Comic Relief they designed a programme to identify girls in major transit towns in Amhara such as Debra Tabor, Woreta and Addis Zemen. The programme, which we are helping to refine, establishes child protection committees comprising leaders of the local community. Members of these committees with Chad-Et’s guidance train their staff to find migrant children, on the road, at bus stations…

In each of the towns Chad-Et is opening a shelter and drop-in centre. Girls who are brought there will have a place to stay for up to seven days while a counsellor works with them and their family to arrange a reconciliation. If there are economic problems -sometimes girls drop out of school for no other reason than an inability to pay for school books or uniforms- a specialist will teach the family how to generate an income. 

Our work this week has been to tighten up and make this intervention as efficient as possible so as to make the most of Comic Relief funds and make a template that others can copy if the approach proves successful. We estimate that the programme will intercept and bring back home 1,200 girls over the next three years. Chad-Et staff will undertake follow-up interviews to see if they girls stay at home, with their basic needs met and with the risks of sexual exploitation absent.

Our trip here is overshadowed by the earthquake in Haiti. In hotel foyers we see pictures from the BBC and CNN of reporters sticking microphones into the faces of people trying to rescue the trapped. But as much as we need to know if flashed at the bottom of the screen -100,000 dead- or from the aerial images of the devastation.

I jog into the bush with Annania who lets me go after a couple of kilometres. Whilst ‘running’ I begin to catch an Ethiopian ahead of me but when he realises he has dropped his pace to that of a fat old white man he kicks up a gear and I watch him slowly draw away. Later I see a real runner, incredibly elegant, whose speed is effortless. I no more imagine I can follow him than I can one of the occasional trucks negotiating the metalled road. Despite my snail’s pace I get plenty of encouragement from the guards with their guns sitting in front of the factories that are beginning to be built in the hinterland of Nazret and the bush. 


70 minutes of jogging and attempted running (10.78 km)

 
15th January, Addis Ababa

A decade ago, in the wake of the AIDS epidemic, Annania Admassu and Alemu Hailu began to address the problem of childhood prostitution in the Ethiopian capital of Addis Ababa. Children as young as 12 years were selling themselves for sex in the central Mercato area of the City.

It is easy to be appalled by this prospect but put yourselves in the position of Annania and Alemu and think about where you would start to right the wrong.

They established a charitable organisation called Children’s Aid Ethiopia, later shortened to Chad-Et. They set up a shelter in Mercato where the girls could come, get showered and clean and, if they wished, to stay for the night. Personal hygiene turned out to be a significant draw for the girls.

Then they put their mind to how to entice the girls away from their way of life. That meant providing basic education, skills and an alternative source of income. The girls were trained to look after each other. They leaned the dances of the regions of Ethiopia (which would allow them to work for dance troupes). Eventually the operation expanded into other income generation activities.

Once there were girls who could sing and dance an opportunity arose to teach local people about the risks to children posed by the sex industry. Annania and Alemu converted a truck into a mobile theatre that toured Mercato and other Addis communities. The girls performed songs and drama that spoke to the misery of child prostitution and for the need for stable child development. The theatre plays to between 500 and 1,000 people three times a week.

Chat-Et is one of ChildHope’s partners. They are proud of the work they have done but they want to know whether they have been effective (hence our visit this week) and whether they could do their work better.

We work long hours so I rise early for my first run at altitude, through a barrio of night clubs that are still going strong at six in the morning. Addis is high and hilly and the air is punctuated by acrid gasoline from cars, buses and trucks. These are all the excuses I can find for such a slow run.

 

30 minutes jogging (4.86km)

 
11th of January, Paignton

Now for the serious business of trying to raise some money. So far I have one contribution from an eccentric in West London. I am expecting to clock up about 450km in training for the run. What’s a reasonable financial target? At least £2 per kilometre would make it worthwhile; with a bit of luck it will be nearer £4 per kilometre or a couple of thousand in total. So now is the time for other eccentrics to make their contribution; at http://www.justgiving.com/Michael-Little/ or just send in the cash and our special deposit service will take over!

Missed two training sessions due to cancelled BA flight in Seattle -they had my luggage and training shoes but no pilot for the plane- and snow on the ground in Dartington. Worked out that there is less snow and ice near to the sea, so resumed the programme in gloomy, mountainless, Paignton.

40 minutes jogging (6.99km)

 
7th of January, Seattle

Beginning my taxonomy of running styles:

-Rocky I, II etc: lot of sideways movement, slight punching action with arms, favoured by more rotund men.

-Prancing Horse: Exaggerated skips of the legs and pronounced arm movements up and down as well as back and forwards.

-Cartoon character: Forward tilting body, slightly desperate look in the face and rapid legs movement but little forward movement.

-Dog walker:  Body tilted forward and one arm permanently stretched out as if holding on to a dog on a lead chasing a rabbit

I wonder if Paula Radcliffe thinks about these things on her record runs?

 

85 minutes of jogging and running (14.2km) plus 10 minute walk in middle

 
6th of January, Seattle

First injury. A small sharp pain that started in my upper right foot has transferred to the front of my left knee. Its travelling upwards in a zig-zag. Where will it go next?  I have an additional pain in my neck that comes on when I switch from jogging to running mode. The knee is complaining about the jogging, the neck about the running. They will both have to get over it.

30 minute jog (5.26km)

 
4th of January, Seattle

Excepting the spectacular mountains, a vibrant City, Microsoft, Boeing and Starbucks, Seattle is just like the South West of England. The Americans didn’t bring the Mountains but they managed the rest in less than a century. It is part of the cradle of world domination slowly drifting West to Asia. But today the City remains a fully functioning port, with real boats, huge ones, little ones, ferries, coast guards, container vessels, grain transporters and fishing boats. And huge railways to get things to and from the boats that go right downtown. This morning I ran past the fuselage of a partly formed Boeing 737 on a train, presumably bound for the place where the wings and engines will be added. So exciting for a boy! (There are even trolley buses connected to electric lines by a long arm). These days, in similar cities, in my home town for example, the port has been shifted out of town and replaced by museum exhibits to remind us of labour. But in Seattle, its all still functioning in full daily view.

35 minute jog (6.02km)

 
3rd of January, Seattle

Still trying to work out the difference between running, jogging and walking as required in the training regime. Today I move slowly up through the gears taking on in my mind the appearance of Haile Gebrselassie as he sprints through the Marathon at a time that I will be lucky to match for the Half Marathon (2 hours and 3 minutes). I even manage to pass someone also apparently running not jogging, which involved me dealing with the risk of him (a) attempting to engage me in conversation or (b) starting a race.

I don’t know if any of this posturing is paying off until the end when my iPod tells me my first run was faster than my first jog but it took its toll to the extent that my last run was slightly slower than my first jog. I cannot imagine Gebreselassie has these problems. Still Lance Armstrong announced via the iPod that this was my longest run yet.

100 minutes of jogging and running (17.06km) plus 15 minutes walking

 
1st January, Totnes

I went to see my dead friend Dave in Cornwall. He lies in a Humanist plot. It takes wisdom to decide to be buried outside the church so unlike him most of the people in his field are old. But he now has another younger companion, a 44 year old who, his wooden plaque points out, was married and a grandparent. Good going for a short life. Much to Dave’s amusement the humanist plot is next to a pet cemetery with headstones far more ornate than given to their human neighbours. Phoebe, ‘our little ray of sunshine,’ a dog, only lived 20 months but has been rewarded by her picture on a huge stone erected by ‘Mum, Dad and Family’. Good going for a Spaniel. What would Dave have thought of me running a Half-Marathon? ‘Make the most of the moment’ was one of his many wise bits of advice to me. I am finding it resonates better after 10 km than 3km.

70 minute jog (10.78km) plus 10 minutes walking

 
31st December, Totnes

Amble past many dog owners. One pulls her little terrier out of the way with the words ‘come here you little rat’. If dogs can understand English as in Dr Dolittle on the television yesterday this terrier must be pretty depressed. Another owner holds onto his Alsatian and says to me ‘he doesn’t like anything fluorescent’ (i.e. my hat).

This is hard work. I am used to running three times a week, 20km in total. Four days into the new regime and I have already covered that distance. Beginning to wonder if there is something between a jog and a walk? 

Nice pictures of Bernadine Dorn and Bill Ayres in Ali’s blog when I get back plus Holocaust survivor Hedy Epstein who is part of the march. At my current pace I could run along the Israeli-Gaza border (51 km) about five hours, and polish off the Israeli-Egypt border (11 km) in an hour. But I cannot. And nor can even the fittest of the one and a half million people locked into these borders.

30 Minute Jog (4.79km)

 
30th December, Totnes

In my enthusiasm started a day early so allow myself two rest days instead of one. Today the regime demands a mix of jogging, running and walking in 15 and 20 minute blocks that add up to an hour and 40 minutes in total.

I find I have no idea about the difference between a jog and a run so move faster than walking pace for 90 minutes and walk for 10.

Think about Ali Abunimah’s blog covering his work with over 1,300 people from 42 countries attempting to break the siege of Gaza. It is a year since the Israeli bombardment of Gaza that killed 1,400 people including 400 children. The Gaza Freedom March is trying to break the siege that has imprisoned the 1.5 million people who live there, conceived in the spirit of Mahatma Gandhi, Nelson Mandela and nonviolent resistance to injustice.

http://aliabunimah.posterous.com/

90 Minute Jog (covered 13.85km) plus 10 minute walk

 
27th December, Totnes

I have to decide between two training regimes offered on the Liverpool Half Marathon website, the beginners and intermediate. I opt for the former and start the eight week course several weeks early.

30 Minute Jog (covered 5.12km)