West Midlands Member Network WELCOME West Midlands Member Network 13th July 2016

Introductions and Housekeeping

Who is EIF? An independent charity launched July 2013 A ‘What Works’ Centre Mission = to promote Early Intervention to improve outcomes for children & young people and save money Early intervention = Targeted activity to respond to emerging signals of risk in child development, before problems become costly and irreversible 3 key functions, rooted in local areas/workforces Pioneering places Better Start areas Additional areas Police leaders

EIF National Conference| 12 February 2015 2.4bn in london EIF National Conference| 12 February 2015

STAGES IN IMPROVING EVIDENCE

Interpreting the evidence 3 ASPECTS OF COMMISSIONING The programme’s journey Strength of evidence of impact is only part of the story. The rating is not the decision. Programmes can go down as well as up. Programmes can go up and down They can split, merge or change. The evidence changes They operate differently in different places or with different families

2 Reviews. 100 Programmes assessed: The parent-child relationship. What Works to support the parent/child relationship in the period up to age 5 years as a means to improve outcomes for children The parental relationship. What works to enhance inter-parental relationships and improve outcomes for children Good quality, effective Early Intervention is not only about programmes. We also focus on the relationship between family and practitioner who may be a health visitor, a family support worker, an early years teacher or a youth worker. And it’s also about the broader systems, how we reach children and families who would most benefit from extra help.

What Works to support the parent/child relationship in the period up to age 5 years as a means to improve outcomes for children? 75 Programmes 3 outcome categories: Attachment Behaviour Cognitive skills 46 % 7% Good quality, effective Early Intervention is not only about programmes. We also focus on the relationship between family and practitioner who may be a health visitor, a family support worker, an early years teacher or a youth worker. And it’s also about the broader systems, how we reach children and families who would most benefit from extra help.

Attachment programmes Forming a secure attachment relationship with the caregiver is a key developmental task of a child’s first year. Majority of parents are able to foster a secure attachment relationship with their child without additional support Some parents struggle to provide this environment, targeted interventions can be highly beneficial for families where there is an identified risk of a disorganised attachment. Approx. 15 percent of toddlers classified as ‘Disorganised or a ‘D’ attachment’ Review identified 31 interventions that primarily aim to support the attachment relationship 2 (6%) Level 4 rating 3 (10%) Level 3 rating 6 (23%) rated 2 or 2+ 15 (48%) not rated/did not have evidence meeting level 2 threshold 2 have evidence from at least one systematic review suggesting no or very few confirmed effects on parent or child outcomes

Behaviour programmes Noncompliant child behaviour is a normal part of toddler development. Most children outgrow this by the time they are three, but some children continue to show problems. There a number of programmes with good evidence of improving children’s behaviour which can prevent problems from becoming worse and improve the parent/child relationship. Evidence based programmes to enhance behaviour tend to be relatively low cost, often based on group activity and of relatively short duration. EIF has found 10 programmes (37%) with good evidence in improving children’s behaviour (Level 3 and 4 Evidence). 15 (56%) are yet to test effectiveness in depth (Level 2 and NL2) 5 programmes have preliminary evidence that they may be effective (Level 2).  10 have not been tested for impact (NL2), but many are based on sound science and implementation design and need further testing.  

Cognitive development Social disadvantage is consistently linked to gaps in young children’s cognitive and language development. The evidence base for the programmes we have identified is relatively weak, The best evidenced programmes to improve cognitive development are the well known US programmes but are not readily available in implementable form in the UK. It is clearly an important area for innovation, evaluation and development. 2 programmes (10%) with good evidence of improving cognitive development (Level 3 and 4 Evidence). 17 of these programmes (85%) are yet to test effectiveness in depth (Level 2 and NL2). 7 programmes have preliminary evidence that they may be effective (Level 2).  A further 10 have not been tested for impact (NL2), but many are based on sound science and implementation design and need further testing.  

2. Impact of conflict between parents on children’s outcomes How parents relate to each other as a couple is a primary influence on children’s mental health and long-term life chances. Children exposed to frequent, intense and poorly resolved inter- parental conflict are at risk of a range of negative outcomes: mental health, attainment, social and emotional skills Parenting interventions in the presence of frequent, severe and unresolved inter-parental conflict – without addressing that conflict – are unlikely to be successful in improving child outcomes.

Strength of Evidence Our knowledge of what works in the UK to support the inter parental relationship is still at an early stage There are some programmes that have been found to be effective outside the UK. But overall are very few interventions which pay attention to parenting quality, co -parenting and the quality of the inter parental relationship We need to build the evidence base as to what works for whom and in what circumstances Need to invest in/adapt and test new interventions in this space

Why this evidence matters? . These reviews provide important new information about: What has been shown to work from conception to age 5 – local commissioners can struggle to apply evidence to local decision making The extent to which the quality of the parental relationship influences outcomes for children – this is often not an issue considered in child or adult services This evidence has implications for a range of audiences Need to shift the dial on IPR as a site for early intervention…a new version of the graph in a few years time?

Evidence in the Real World what have we learnt from EIF Places? Work with 13 EIF Pioneering Places in 2014: Three quarters of known programmes commissioned locally did not have sufficient evidence to be considered evidence based One area: 22% of EI budget on programmes known to have no effect for children 2015 Survey of 28 multi-agency systems for early intervention in 2015: 25% wanted to evaluate but didn’t know how Others had process monitoring, but none had evidence of impact on child outcomes Evaluation as most common request to EIF – The evidence base in relation to early intervention is largely about programmes Questions about how useful specific research in controlled settings is when applied to more complex & changing local systems RCT prominence can alienate those at the other end of the spectrum Lack of resource and analytical capacity in many local areas Lack of culture and experience of evidence use and generation across children’s services – focus on professional judgement both of systems and programmes.

What Now? Important messages for early years commissioners – using this evidence to inform local decisions about what services to commission & deliver A national dissemination programme to drive use of this evidence Aims Better understanding of what is spent on targeted EI Increased proportion of spending on things with good evidence of effectiveness Measuring the impact of carefully commissioned Early years services which fit local population need

Find out more at: www.EIF.org.uk Contact us at: info@eif.org.uk Follow us: @TheEIFoundation