Notes from Michael Littles presentation

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Notes from Michael Littles presentation

• These notes refer to some of the points Michael
  Little made during his presentation at the
  Cumbria, Lancashire and Cheshire Childrens Fund
  Meeting
• Much of the data and discussion about the
  well-being of children in UK and the impact of
  prevention innovation since 1997 are contained on
  the Prevention Action website, a daily
  publication covering breakthroughs in prevention
  science and application to policy and practice.
• Prevention Action also contains valuable
  resources such as databases of good practice, and
  links to other reliable sources around the world.
• It can be read at www.preventionaction.org

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• Another helpful way of thinking about innovation
  is to consider possible chains of effect that may
  lead to the outcome to be improved.
• For example, one of several routes to anti-social
  behaviour is poor housing, that leads to parental
  depression, that reduces the quality of
  parenting, which in turn contributes to
  anti-social behaviour.
• The idea is represented in the following diagram.

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• Many interventions for anti-social behaviour are
  focused on treating the symptoms and working with
  the child.
• An alternative logic would be to reduce risks
  that lead to anti-social behaviour.
• In the following illustration, all the
  interventions are focused on reducing risks, and
  all concentrate on adults, although the major
  beneficiary is intended to be the child, and
  their reduced anti-social behaviour.

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• Another way to think about the problem is to
  break the chains that connect the risks.
• The following example assumes that nothing can be
  done about the poor housing or the parental
  depression.
• After-school support takes the child out of home
  for longer periods. Quite apart from any direct
  benefits it reduces over-crowding for parts of
  the day.
• Mentoring that offers one-significant adult (OSA)
  into the childs life may break the next part of
  the chain.

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• The presentation indicated several sources of
  information about proven models from around the
  world.
• Some are listed on the reference page of the
  Prevention Action site.
• The Blueprints for Violence Prevention site is
  extremely helpful, and lists just 11 programmes
  that meet strict inclusion criteria.
• http//www.colorado.edu/cspv/blueprints/index.html
  
• The Best Evidence Encyclopedia is a good source
  for education programmes.
• http//www.bestevidence.org/

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• Proven models from elsewhere rarely provide the
  answer to local problems. But much can be learned
  from the way in which other people have gone
  about designing services and from the logic that
  underlies the approach.
• It is depressing that so little of the innovation
  in the last decade has resulted in programmes
  that carry the features of effective prevention
  services, such as
• Clarity about the target group and the risks to
  be reduced
• A clear logic model and realism about impact on
  outcomes
• A statement of ethics,
• A preparedness to treat the innovation as a
  hypothesis that requires rigorous evaluation to
  estimate its impact on childrens lives

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• Much of the presentation focused on the failure
  of childrens services, including Childrens
  Fund, to rigorously evaluate innovation.
• The best way to evaluate the impact of an
  intervention on child outcomes is an experimental
  evaluation or randomised controlled trial or RCT
  -see Prevention Action for definition.
• RCTs are not the only form of evaluation, and
  they are not the best way to answer other
  important questions such as whether or not a
  design is well implemented.

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• The perils of not evaluating using experimental
  methods are explored in several stories in
  Prevention Action see for example
• http//www.preventionaction.org/prevention-news/is
  nt-it-time-start-finding-out-if-sure-start-childre
  n-centers-work
• Sure Start is expensive. The evaluation indicates
  few beneficial effects, and some negative. But
  the design means we do not know if the results
  are due to Sure Start being ineffective or the
  evaluation being misleading.
• Michael Rutters article Is Sure Start an
  Effective Preventive Intervention? in Child and
  Adolescent Mental Health, 11 (3), 135-141, 2006
  is an excellent summary of the problem.

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• There was much conversation about the public
  health approach to prevention. The basic idea was
  set out in terms of alcohol consumption in the US
  and UK, and illustrated in the following slide.
• The idea is that by reducing the average amount
  of alcohol consumed by the average drinker in the
  UK (to levels in the US), over an extended period
  of time, the tail of the distribution, that is
  the proportion of alcoholics, would also shift.

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Universal Prevention Alcohol Intake in the UK
and US
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• In one of the exchanges, the practical question
  about how to measure outcomes was raised. There
  was not time for a full answer. But the following
  slides may help.
• The three slides are from one study in
  Birmingham. It is based on reliability -different
  people completing the same instrument on the same
  child arrive at the same conclusion- and
  validity -the instrument measures what it is
  intended to measure- of instruments applied to a
  representative sample of children. There is good
  comparison data for most of the measures listed.
• Dartington and other research organisations have
  good databases of reliable measures.
• The two results slides give data on what is
  happening to ordinary children -the mean in the
  distribution- and to those whose development is
  impaired -the tail of the distribution.

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KIDSCREEN TISH (Things I Have Seen and
Heard) SDQ (Strengths and Difficulties
Questionnaire) PWI (Personal Well-Being Index)
PLQ (Personal Lifestyles Questionnaire) PSI
(Parenting Style Inventory)
instruments
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2.8
0
10
0.7
4.9
2.2
0
10
0.5
3.9
n 5,858 all (7-18 yrs) Britain (11-15 yrs)
mental health behaviour
SDQ
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Birmingham 7-18
comparison
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n 5,858 all (7-18 yrs) Britain (11-15 yrs)
mental health behaviour
SDQ
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further resources