The Best for Every Child - Public Health Agency · A consensus has development amongst neuro-scientists, psychologists, economists and others concerned with the development of children

A report on the potential to transform disadvantaged communities in Lisburn through early intervention

The Best forEvery Child

Researched and written by Barnardo’s NI, commissioned by Resurgam TrustDr Roger Courtney

Public HealthAgency

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Contents

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i. ExecutiveSummary 2

1. Introduction 6

2. TheNeedsofDisadvantagedCommunitiesinLisburn 10

3. WhyEarlyIntervention? 37

4. PublicPolicyContext 46

5. TheoryofChange 75

6. OperatingModel 95

7. ImplementationPlan 102

8. Bibliography 108

Appendices

1. TermsofReference 114

2. MembershipoftheEarlyInterventionSteeringGroup 116

3. Summariesofprovenearlyinterventionprogrammes 117

4. EarlyInterventionSites&programmesintheUKandIreland 198 (Nottingham,youngballymunandWestTallaghtCDI)

Thetitleofthisreport,“Thebestforeverychild”isaquotefromoneoftheparentswhoparticipatedintheconsultationsduringtheresearchphaseindevelopingthisreport

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1. IntroductionThisfeasibilitystudyandconsultationwascommissionedfromBarnardo’swithfundingfromthePublicHealthAgency,byResurgamDevelopmentTrustrepresentingcommunityandyouthorganisationsindisadvantagedcommunitiesintheCityofLisburn,includingOldWarren,Hilden,Hillhall,Tonagh,KnockmoreandLaganValley.Itinvolvedconsultationswithaverywiderangeofcommunityorganisations,schoolsandprofessionalagenciesworkinginLisburn.Italsoincludedresearchinto:theneedsofthetargetareas;thedesiredoutcomesforchildrenandyoungpeople;theevidenceandargumentsfortakinganearlyinterventionapproachtotheissues;thepublicpolicycontextandtheextentthatitmightsupportanearlyinterventionapproach;andtheevidenceofthepotentialimpactofdeliveringparticularprovenprogrammesinthetargetareasofLisburn.

2. TheneedsofdisadvantagedcommunitiesinLisburnResearchintotheneedsofdisadvantagedareasofLisburncomplementedbyconsultationswithlocalcommunitygroupsandprofessionalsworkinginthetargetareasidentifiedverysignificantissuesconcerningthehealth,wellbeing,safetyandsecurityofthepopulationintheseareas,whichhaveaverydetrimentaleffectonthelivesofmanyfamilies.Concernsaboutparentingwerealsoveryprominentinmostoftheconsultations.Thesefindingsareconsistentwiththeinternationalliteratureoninequalityanddeprivationonarangeofwellbeingindicators.

Whatwasmoreshockingwastheverypooreducationaloutcomesofthechildrenandyoungpeople,rightfromprimaryschool.Ofthoseattendingthethreepost-primarycontrolledandintegratedsecondaryschoolsinLisburn,three-quartersleaveschoolwithout5+GCSEswithEnglishandMathsandveryfewgoontouniversityorcollege.Therewassignificantevidenceofeducationalunder-achievementbeingreplicateddownthegenerations.Thenatureofemploymentinthe21stCenturywouldsuggestthat,asaresultofpooreducationalachievement,thelevelofdeprivation,andtheextentofpoorhealthandwellbeing,intheseareaswill,ifnotarrestedbyamajorintervention,increasefurtherinfutureyears.Itwasclearfromtheresearchthattinkeringattheedgesoftheproblemwillnotbeenoughtotacklethischronicproblem:asubstantialandcomprehensiveinitiativeisurgentlyrequiredifthenextgenerationoflivesofchildrenandyoungpeopleisnottobeblighted.

3. WhyEarlyIntervention?Aconsensushasdevelopmentamongstneuro-scientists,psychologists,economistsandothersconcernedwiththedevelopmentofchildrenandyoungpeoplethat:■ 80%ofbraindevelopmenthappensbeforeachildisthreeyearsoldandsothese

arethemostcriticalyearstoinvestinthedevelopmentofthechild;

Executive Summary

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■ investingintheseearlyyearsandintheearlystageswhenchallengesinachild’slifearebecomingevidentarebothmoreeffectivethaninvestingindealingwiththechroniclaterphasesoftheseproblems;

■ investingintheearlyyearsofachild’slifeandtheearlystagesofsocialproblemsbeforetheybecomechroniccanproduceverysubstantialsavingstothepublicpurseinlateryears;

■ preventionscienceiscriticallyimportantindemonstrating,throughrobustresearch,usuallyinvolvingrandomcontroltrials,whatinterventionsactuallywork;and

■ beingclearaboutthespecificoutcomesthatanyinterventionisdesignedtoimpactonisvitallyimportant.

4. PublicPolicyContextAlthoughtheconceptsaroundanearlyinterventionapproachhaveonlybecomecommonlydiscussedinternationallyinthelastdecade,theyhavenowhadasignificantimpactonthestrategicthinkingofarangeofgovernmentdepartmentsandagenciesinNorthernIreland,whichnowemphasiseprevention,earlyinterventionandevidence-basedpractice,althoughactualimplementationoftheapproachisstillataveryearlystage.Itrequiresalonger-termperspectiveinrealisingthesavingstothepublicpurseofsuchanapproachandthebreakingdownofdepartmentalsilos,asthepositiveoutcomesofaninvestmentfromonedepartmentmayaccruetoanotherdepartment.

5. TheoryofChangeThereportoutlinesalogicmodelwhichdemonstratesthelinksbetweentheinvestmentofresources;theprogrammestobedelivered;theoutputsfromtheseprogrammes;theoutcomesintermsofchangedlives;andhoweachofthesecanbemeasured.Thelogicmodelsuggeststhatthefollowingoutcomesshouldbeaddressed:■ Reducednumberofteenagepregnancies■ Reducedlevelofsmokingduringpregnancy■ Improvedparentingskillsandconfidence■ Improvedparent-childattachmentfor0-2yearolds■ Improvedschoolreadinessamongst3&4yearolds■ Improvedliteracyandnumeracyinchildrenaged4-11■ Improvedsocialandemotionalskillsandresilienceof4-11yearolds■ Improvedschoolattendance■ Improvededucationalaspirationsandattainmentonleavingschool■ Reducedbehavioural/conductproblems■ Reducedsmoking,alcoholanddrugconsumptionamongstyoungpeople■ Reducedcrimeandanti-socialbehaviouramongstyoungpeople

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Effectiveinterventionsneedtocommencewithafamilybeforeachildisbornandcontinueatleastthroughprimaryschoolage.Theyneedtoincludeuniversalprogrammesaswellastargetedservices.

Inordertoaddressthis,theapproachproposedhastwokeyelements:

1) AlthoughLisburnisunder-servedinrelationtosupportforchildrenandfamilies,asitdoesnotreceiveregenerationfundingsuchasNeighbourhoodRenewal,despitehavingareaswithinthe10%mostdeprivedinthe2010MDMfiguresandhasmuchworseeducationaloutcomesthanareaswithintheworst10%,thereisstillaneedimprovetheco-ordination,effectivenessandintegrationofexistingservicesforchildren,youngpeopleandfamiliesintheLisburnareabydevelopingacommonoutcomesframework(whichwillenableimpacttobemeasured),creatingasharedfocusonqualityachievedthroughjointreflectivepractice,trainingandpeerlearning,wherebydifferentorganisationscanlearnfromoneanother.Inaddition,allexistingorganisationswillneedtoworktogethertotransformtheculturewithintheCityofLisburn,especiallywithinareasofdeprivation,toemphasiseaspirationandachievement(particularlyinrelationtoeducation).

2) ThescaleoftheprobleminLisburn,whereby75%ofpupilsfromallofthethreecontrolled/integratedschoolsleavewithouttheminimum5CGSEwithMathsandEnglish,issuchthatsignificantnewsustainableinvestmentisneededinnewinterventionstobreakthecycleofpooroutcomes,whichislikelytoonlygetworse.TheseneworenhancedinterventionsmustcomplimentandworkalongsideexistingcommunityserviceswithinLisburnsothatallservicesareworkingtogetherunderacommonoutcomesframework.Theneworenhancedinterventionsshouldalsohaveclearlydemonstratedeffectivenesssothatconfidencecanbegainedthattheywilldeliverthelevelofimprovementrequired.

Specificinterventionswillbeidentifiedbythemulti-agencyEarlyIntervention

LisburnConsortiumoncefundingisinplace,butarelikelytoincludeinterventionsbasedon:■ intensivehomevisiting;■ parentingtraining;■ pre-schoolearlyyearschilddevelopment;■ additionalliteracysupportintheprimaryyears;■ socialandemotionaldevelopment;and■ mentoringsupport.

Executive Summary

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6. OperatingModelThereportoutlinesanoperatingmodelfordeliveringtherecommendedprogrammesinLisburnwhichwillbebothownedbythelocalcommunity;fullyengageallthekeystakeholderswhohaveaninterestinoutcomesforchildrenandyoungpeopleinthetargetareasinacollaborativeapproach;andbedeliveredbyanagencywithstrongexperienceindeliveringearlyinterventionprogrammesforchildrenandfamilies.

TherearealsoconsiderableadvantagesindevelopingacloserelationshipwithotherareasthathavedevelopedanEarlyInterventionapproach.ApartnershipwiththeEarlyInterventioninitiativeinDerry-Londonderry,whichisatasimilarstagewouldhaveparticularadvantages.

7. ImplementationPlanThereportoutlinesamedium-termimplementationplaninphasesfortakingforwardtherecommendationsinthereport.ThephasedapproachedallowsforthepotentialfindingsfromthelargenumberofRCTevaluationsthatwillreportoverthenextfouryearsinfuturephasestobetakenonboard.

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CHAPTER ONE

Introduction

ThisreporthasbeencommissionedbyResurgamDevelopmentTrustandfundedbythePublicHealthAgencytoexplorethefeasibilityofanearlyinterventioninitiativetobreakthecycleofunder-achievementamongstchildrenandyoungpeopleindisadvantagedcommunitiesinLisburn.TheconceptofEarlyInterventionLisburnhasbeenpioneeredbytherecentlycreatedResurgamDevelopmentTrustrepresentingawiderangeofcommunityandyouthorganisationsindisadvantagedareasinLisburn.

Lisburnisarecentlydesignatedcitytothesouth-westofBelfastontheRiverLagan.Ithasagrowingpopulationof117,836.Itisanareaofsharpcontrasts.ItcontainssomeofthemostprosperousareasinNorthernIreland(includingWallacePark–themostprosperous),aswellasaseriesofdisadvantagedhousingestatesbuiltinphasesbetweentheendofWWIIandthe1970stoencouragepopulationgrowthawayfromBelfast.TheseestatesincludethepredominatelyProtestant/Unionist/LoyalistOldWarren,Hillhall,HildenandthemoremixedKnockmoreand

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12 1315

1416

189

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1 Knockmore2 Old Warren3 Tonagh4 Lagan Valley5 Hilden6 Hillhall

7 Ballinderry8 Maghaberry9 Maze10 Ballymacross11 Ballymacash12 Lisnagarvey

13 Wallace Park14 Magheralave15 Harmony Hill16 Lambeg17 Drumbo18 Blaris

1 2 34

5 6

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Tonaghestates.TherearealsosignificantsmallerpocketsofdeprivationaroundLisburn,includinginBallymacashandMilltown/Derriaghy.

Twinbrook,Poleglass,KilweeandColinGlen,whilecurrentlywithintheLisburnLocalGovernmentArea,identifymorewithWestBelfast;willbecomepartofBelfastCouncilareafollowingtheimplementationoftheReviewofPublicAdministration;andarealreadypartofthesuccessfulColinEarlyInterventionCommunityandsohavenotbeenincludedinthisstudy.Theprocessofdevelopingthisreporthasinvolved,inadditiontoextensivedeskresearch,aseriesofconsultationmeetingsandworkshopswithcommunities,schoolprincipals,voluntaryorganisationsandstatutoryagenciesworkingwithindisadvantagedareasinLisburn.Participantsinconsultationworkshopsandinterviewshaveincludedthefollowingwhohavemadeavaluablecontributiontothedevelopmentofthestrategy:

AdrianArbuthnot–DepartmentofEducationNIAnnieArmstrong-ColinNeighbourhoodPartnershipAdieBird–ChairoftheEarlyInterventionLisburnSteeringGroup/ResurgamOwenBrady–NorthernIrelandHousingExecutiveSoniaBrown–HildenCommunityAssociationCaitlinBurns-HillhallRegenerationGroupTonyCanavan–DepartmentofJusticeNILouiseClarke–HildenCommunityAssociationRosieColquhoun–KnockmoreCommunityAssociationPatriciaConnelly–TonaghWomen’sGroupJonathonCraigMLA–MemberoftheNIAssemblyEducationCommitteeEvelynCurran-EasternChildcarePartnershipMichaelDevine–SouthEasternEducationandLibraryBoardMartinDevlin–SouthEasternHealth&SocialCareTrustSharonDickson–LisburnYMCAKieranDrayne-ColinEarlyInterventionCommunityFrancisFerris–TrainingForWomenNetworkandHillhallCommunityAssociationSharonGibson–Resurgam/LisburnPSPPaulGivanMLA–ChairofAssemblyJusticeCommitteeSamHamilton-OldWarrenCommunityAssociationAnnHardy–Children&YoungPerson’sStrategicPartnershipJulieHealy–Barnardo’sSharonHeazley–NorthernIrelandHousingExecutiveHildenWomen’sGroupFionaIrvine–TonaghWomen’sGroupIngridIrvine–TonaghWomen’sGroup

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PamelaJames-KnockmorePrimarySchoolMaureenJamison–SouthEasternHealth&SocialCareTrustMauraJohn-OldWarrenCommunityAssociationSheenaKerr–TonaghWomen’sGroupTommyKynes-OldWarrenCommunityAssociationAliceLennon-SouthEasternEducationandLibraryBoardJulieLenaghan–TonaghWomen’sGroupHelenLewis-BrownleePrimarySchoolMonicaMcCann–Barnardo’sEamonMcCarthy–DerryHealthyCitiesPatriciaMcCormick–HildenCommunityAssociationJimMcLaughlin–DerriaghyCommunityAssociationMargaretMcCormick-FortHillCollegeNeilMcGivern–SEELBPaulineMcMillan-LisburnYMCAJamesMartin-LaurelhillCommunityCollegeMonicaMeehan–SouthEasternEducationandLibraryBoardYouthServiceEdwardMilliken–HillhallRegenerationGroupLawrenceMilliken–HillhallRegenerationGroupJasonMilliken–HillhallRegenerationGroupTonyMorgan–UniversityofUlsterGailMullan-HillhallRegenerationGroupAshleyMulligan-KillowenPrimarySchoolOldWarrenWomen’sGroupDenisPaisley–OldWarrenYouthInitiativesSarahJanePatterson–CommunityworkerKnockmore/TonaghHeatherPhillips–HildenCommunityAssociationPaulPorter–LisburnCityCouncilorTanyaPorter–HildenCommunityAssociationMarianQuinnandotherstaff–TallaghtWestChildhoodDevelopmentInitiativeSeamusQuinn-StPatrick’sAcademyGordonRea–HildenCommunityAssociationJimRose–LisburnCityCouncilMabelScullion–PublicHealthAgencyJimSheerin-LisnagarveyHighSchoolDavidSmith-SouthEasternRegionalCollegeClaireSpiers-TonaghPrimarySchoolJulieStephenson–DepartmentofEducationNIHarryStewart-LargymorePrimarySchoolIanSutherland-SouthEasternHealth&SocialCareTrustFionaTeague–DerryHealthCitiesJohnTodd–DepartmentofJusticeNI

CHAPTER ONE

Introduction

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ChrisTotten–PublicHealthAgencyLisaTucker–RaggedyBapLauraTurner–Ballymacoss/NorthLisburnAnneWatsonKnockmoreCommunityAssociationJasonWhite–SouthEasternHealth&SocialCareTrustAndrewWilliamson-OldWarrenPrimarySchool

TheresearchandconsultationswereguidedbytheEarlyInterventionLisburnSteeringGroup(listofmembersofthesteeringgroupareshowninAppendix1).

Thereportisinsixmainsections:

Section 2 looksattheneedsofdisadvantagedcommunitiesinLisburninrelationtohealth,wellbeing,parenting,safety,securityandeducation.

Section3explorestheconceptofEarlyInterventionandwhyithasbecomecriticalinthedevelopmentofthinkingaboutsocialprogrammesinternationallyaswellasintheUKandIreland.

Section 4explorestherelevantNorthernIrelandpublicpolicycontextanditsrelevancetotheEarlyInterventionevidence-basedapproach

Section 5outlinesaTheoryofChangeandLogicModelandassessesandhighlightstheevidence-basedprogrammesthathavebeenshowntomakeasignificantimpactontheoutcomeswhichareappropriateforEarlyInterventionLisburn

Section 6exploresthemostappropriateoperatingmodelforengagingallthekeystakeholdersindeliveringtheEarlyInterventionLisburnvision

Section 7providesasuggestedimplementationplanfortakingforwardtheearlyInterventioninitiative.

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CHAPTER TWO

The needs of disadvantagedcommunities in Lisburn

2.1IntroductionThefollowingsectionoutlinestheissuesofconcernthatwerehighlightedincommunityconsultations,alongwithananalysisandsummaryoftheavailabledataonvariousformsofdisadvantageinthetargetareasinLisburnwhichpreventchildrenandyoungpeopleachievingtheirpotential.

TheNorthernIrelandStatisticsandResearchAgency(NISRA)gathersdataonallwardsandSuperOutputAreas(SOAs)inNorthernIrelandfromavarietyofsources,whichitdisseminatesthroughitsNINISdatabase.ThisdataprovidesarangeofimportantinformationaboutthetargetdisadvantagedcommunitiesinLisburn.

SomeoftheanalysisbelowreferstoelectoralwardsandotherstoSuperOutputAreas(SOA),wheretheinformationisavailable.SomeSOAsareco-terminuswiththeelectoralwards(e.g.OldWarrenandTonagh).InHillhall,HildenandKnockmorewards,however,therearetwoSOAsineachward.TheboundariesofwardsorSOAsmaynotbethesameastheboundariesofacommunityasperceivedbytheresidentswithinthoseboundaries.TheKnockmoreestate,forexample,isinOldWarrenratherthantheKnockmoreward.PartoftheOldWarrenestateisinLaganValleyward.

SignificantpocketsofdeprivationcanalsobecontainedwithinawardorSOAthatalsocontainscomparativeaffluence,sothatthescores/rankingsfortheward/SOAmaymasktheexistenceofthesesmallerpocketsofdeprivationaroundLisburn,includinginBallymacoshandMilltown/Derriaghy.

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Population(bywardandSOAs)*Theestimatedpopulations(andreligiousbreakdown)ofeachofthetargetwardsandSOAsin2011areasfollows:

OldWarren(70.4%Protestantand24.9%Catholic) 2,401

Tonagh(62%Protestantand35.4%Catholic) 2,537

Hillhall(90.2%Protestantand5%Catholic 2,815

Hillhall1(88.7%Protestantand5.9%Catholic) 1,412

Hillhall2(76.1%Protestantand18.4%Catholic) 1,403

Knockmore(76.1%Protestantand18.4%Catholic) 3,537

Knockmore1(73.4%Protestantand22.8%Catholic) 1,862

Knockmore2(79.2%Protestantand13.6%Catholic) 1,675

Hilden(89.5%Protestantand5.4%Catholic) 2,826

Hilden1(84.2%Protestantand8.7%Catholic) 1,351

Hilden2(94.4%Protestantand2.4%Catholic) 1,475

LaganValley 2,967

LaganValley1SOA(84.6%Protestant;8.9%Catholic) 1,379

Totalpopulation 17,083

NumberofChildren(under16)*Theestimatedtotalnumberofchildreninthetargetareasin2010areasfollows:

Ward SOA Totalno.ofchildren

0-2yearolds 3-5yearolds

OldWarren OldWarren 600 116 128

Tonagh Tonagh 512 79 97

Hillhall 611 122 115

Hillhall1 296

Hillhall2 316

Knockmore 757 157 242

Knockmore1 329

Knockmore2 427

Hilden 588 110 112

Hilden1 293

Hilden2 294

LaganValley 573 98 119

Alltargetareas 3,641 682 717

*NINISwardandSOAprofiles(www.ninis.nisra.gov.uk–lastupdatedOctober2011)

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Births*Therewerethefollowingnumberofbirthsinthetargetareasduring2009/10:

Derryaghy1 119(2010/11)

Knockmore 73

Hilden 57

Tonagh 44

OldWarren 41(46in2010/11)

Hillhall 37(23inHillhall1SOAin2010/11)

LaganValley 36

Totalnumberofbirths: 288

2.2MultipleDeprivationThissectionlooksattheNINIScompositemeasureofdeprivation*andsomeoftheviewsthatemergedfromthecommunityconsultations.

Multi-deprivation2010rankings*ThefollowingaretheMDMrankingsforthetargetareasofLisburnoutof582wardsand890SOAs:

Ward MDM ranking CommentsOldWarren 32nd Withinthe10%mostdeprivedwards

Tonagh 103rd Withinthe20%mostdeprivedwards

Hilden 154th Withinthe30%mostdeprivedwards.Hilden1SOAisranked299thoutof890SAOs;Hilden2isranked227th

LaganValley 156th Withinthe30%mostdeprivedwards;SOALaganValley1isranked231stoutof890,justoutsidetheworst25%mostdeprivedSOAs

Hillhall 203rd SuperOutputAreaHillhall1isoneofthe20%mostdeprivedSOAsinNI–ranked145th

Knockmore 285th SOAKnockmore1isranked550thoutof890;Knockmore2SOAisranked310th


CHAPTER TWO


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Economicwellbeing–incomesupport(2011)*

OldWarren ConsistentlymuchworsethantheNIaverageonallincomesupportindicators.ItismorethantwicetheNIaverageforthenumberofchildrenlivinginincomesupporthouseholds.Itistwoandthree-quarterstimestheNIaverageforloneparentsclaimingincomesupport

Tonagh WorsethantheNIaveragefornumberofchildreninincomesupporthouseholdsandnumberofloneparentsclaimingincomesupport

Hilden ConsistentlyworsethantheNIaverageonallincomesupportindicators

Hillhall WorsethantheNIaverageonthenumberofchildreninincomesupporthouseholdsandloneparentsclaimingincomesupport

Knockmore 18%abovetheNIaverageofnumberofincomesupportclaimantsandincomesupportclaimantswithadisabilitypremium

LaganValley 20%abovetheNIaverageforincomesupportclaimants;athirdabovetheNIaveragefornumberofchildreninincomesupporthouseholds;and57%abovetheNIaverageforloneparentsclaimingincomesupport

CommunityConsultationsConsultationswithcommunitiesandprofessionalsworkinginthetargetareas(seethelistofconsulteesintheIntroduction)highlightedtheseriousimpactofsocio-economicdisadvantageonfamiliesinthetargetcommunities.

Onecommunityrepresentativedescribedthesenseofeconomicexclusionfromlocalfacilities,suchasthenearbyleisurecentreandactivitycentre,whichareunaffordabletomanyfamiliesonlowincomes.Thesamerepresentativealsodescribedthechallengesforlowincomefamilieswhohaveachildwhogainsaplaceinagrammarschoolwhichexpectsparentstopaya“voluntary”fee,plusthecostoftheuniform,schooltrips,tuition,etc.Middleclassfamiliescanaffordtopayforspecialtutorstohelpensurethechildpassesthe11+tests,andgainsextrahelpwithkeysubjectsiftheyrequireit,aswelltheotheradditionalcontributionsexpectedbygrammarschools.

Thecommunityconsultationshighlightedconcernsaboutincreasinglevelsofunemployment(althoughlowerthanmanyotherareasofsignificantdeprivation);theincreasingnumberofjobswhicharetemporary,part-timeand/orlowpaid;andproblemsofunemployabilityduetothelowlevelsofeducationalachievement,discussedbelow.

Theconsultationsalsohighlightedtheimpactofa“benefitsculture”particularlyforfamilieswhereno-oneisworking,where,toenhancetheirmeagreincomes,theireffortsareoftenfocusedonmaximizingbenefitsclaimsformedical


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conditionsordisabilitiesamongsttheparentsandchildren.Thebenefitstrapwhichmakesitdisadvantageousforparentstotakeuplowpaidemploymentbecausetheywillbeworseoffwasalsohighlighted.

Thelackofaffordablechildcarewasalsocitedasanotherbarrierinparentsgainingpaidemploymentduringvariousoftheconsultationswithcommunityandwomen’sgroupsinthetargetareas.Itissupportedbythelackofidentifiableall-daychildcareprovisionintheareas.

2.3EducationThissectionexplorestherelevantdataoneducationalperformance(basedon2009/10statisticsfromDENI).IthighlightstheinadequateeducationaloutcomesformanychildrenindisadvantagedcommunitiesinLisburn,muchofitreflectingtheenvironmentalfactorsinthelivesofthechildren.

PleasenotethatstatisticalinformationbywardprovidedbyNINISisfromtheyear2009/10.StatisticalinformationfromtheDepartmentofEducationonschoolperformanceisfortheyear2010/11

Percentageofpost-primarypupilsentitledtofreeschoolmealsMostlyconsistentwiththeMultipleDeprivationMeasuresforeachward,highlightedabove,thefollowingarethepercentageofchildrenentitledtofreeschoolmealsineachward:

0 10 20 30 40 50 60 70 80 90 100

Knockmore

Hilden

Hillhall

Lagan Vallet

Tonagh

Old Warren 39.9%

(a much lower % than would be suggested by the ward’s multiple deprivation ranking)

26.4%

23.8%

17.6%

17.6%

11.1%

NI average 16.7%

CHAPTER TWO


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Percentageofpupilsstatemented/SENyears1-7AllthetargetwardsareabovetheNIaverageof18.9%,intermsofthepercentageofpupilsinschoolyears1to7,whohavebeenstatementedasaresultoflearningdifficultiesordesignatedashavingspecialeducationalneeds,exceptforKnockmorewhichisbelowaverage(15.4%):

Atpost-primarylevel,morethanonequarter(27.7%)ofstudentsatLaurelhillCommunityCollegehavespecialeducationalneeds;20.9%atFortHillCollege.and13.3%atLisnagarveySecondarySchool.

SpeechandlanguagedifficultiesThenumberofspeechandlanguagereferralsforchildrenagedunder16atthetimeofreferralinthetargetareasareshowninthetablebelow:

LISBURN WARD New Review Group Contact

Can C Did not respond /attend

Grand Total

Multiple Deprivation Ranking

BALLYMACOSS 45 705 353 112 46 1261 395

DERRYAGHY 64 667 289 89 68 1177 198

HILDEN 17 315 254 36 30 652 154

LAGANVALLEY 16 375 194 35 19 639 156

TONAGH 15 318 230 31 15 609 103

BALLYMACASH 20 371 146 28 25 590 575

BLARIS 12 376 156 25 15 584 470

OLDWARREN 17 243 261 31 19 571 32

HILLHALL 17 282 220 22 25 566 203

KNOCKMORE 27 239 92 47 35 440 285

TWINBROOK 12 243 116 19 34 424 10

POLEGLASS 30 213 90 39 42 414 80

WALLACEPARK 11 174 54 15 14 268 582

LISBURN(allwards)Total

619 9230 4736 1191 753 16529

Twinbrook,PoleglassandWallaceParkwardshavebeenincludedbywayofcontrast.

0 10 20 30 40 50 60 70 80 90 100

Knockmore

Hillhall

Hilden

Tonagh

Lagan Valley

Old Warren 41.8%

28.8%

26.2%

23.9%

21.8%

15.4%

NI average 18.9%

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Itmighthavebeenexpectedthatchildrenfrommoredeprivedwardsarelikelytoexperiencegreaterproblemswiththeirspeech/language.Thistable,however,doesnotconfirmanyrelationshipbetweenthelevelofdeprivationofawardandthenumberofreferralsofchildrenwithspeechandlanguagedifficulties.Thelackofanyexpectedrelationshipmaybetodowiththeconfidenceofmoremiddle-classparentstoaccesstheservicestheyfeeltheirchild,whoisexperiencingspeechorlanguagedelays,requires,counterbalancinganyrelationshipwithdeprivation.

Percentageofpoorattendance(lessthan85%)atprimaryschoolAllthetargetwardsareworsethantheNIaverageof5.5%intermsofchildrennotachieving85%attendanceatprimaryschool:

Sub-domain for primary school rankingNINIScalculatesasub-domainscoreandranking,basedindatafrom2006/7-2007/8.Itiscalculatedusingthreesetsofindicators:■ The%ofchildrenachievinglevel4orhigheratkeystage2■ The%ofchildrenwithspecialeducationalneeds■ Thelevelofabsenteeism

ThegeneralrelationshipbetweentheSOANINASprimaryschoolsub-domainrankingsandtheMultipleDeprivationrankingsishighlightedinthetablebelow.However,theHildenSOAs(withamultipledeprivationrankingsof227and299)haveprimaryschoolsub-domainrankingsof117thand119th,whicharemuchworsethanwouldbeexpected.Tonagh,LaganValley1,Knockmore1andHillhall2arealsoworsethanwouldbeexpectedfromtheMultipleDeprivationRankings.OldWarrenandHillhall1arebetterthanwouldbeexpected.

0 10 20 30 40 50 60 70 80 90 100

Knockmore

Tonagh

Hillhall

Old Warren

Lagan Valley

Hilden

NI average 5.5%

12.1%

11.6%

8.4%

7.0%

6.9%

5.5%

CHAPTER TWO


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SOA Primary School Ranking MDM Ranking CommentsHilden2 117th 227 Withintheworst15%ofSOAs

Hilden1 119th 299 Withintheworst15%ofSOAs

OldWarren 129th 85 Withintheworst15%ofSOAs

Tonagh 138th 192 Withintheworst15%ofSOAs

LaganValley1 187th 231 Withintheworst25%ofSOAs

Knockmore2 312th 310

Knockmore1 383rd 550

Hillhall1 397th 145

Hillhall2 430th 612

PrimarySchoolPerformanceatKeystage1and2(EnglishandMaths)1

Theexpectationisthatallprimaryschoolpupilswillachieveatleastlevel2EnglishandMathsatkeystage1andlevel4inEnglishandMathsatKeyStage2.

ThetablebelowshowsthenumberofprimaryschoolsinLisburnthatdonotenable90%oftheirpupilstoachievethesestandards,outofapossiblemaximumof14schools.Theyarepartlybasedonsubjectiveteacherassessmentssotheyneedtobetreatedwithsomecaution.

Stage and Level

The number of primary schools not achieving 90% of the target

The number of primary schools in Lisburn achieving below the NI average for that band of free school meal entitlement

Comments

KeyStage1Level2English

5 6 3oftheschoolsnotachieving90%haveafreeschoolentitlementof30%+.ThreearecurrentlyExtendedSchools2,twoofwhichhavenurseryclasses.Twoarebelowtheirtargetintake

KeyStage1Level2Maths

3 8 Only1oftheschoolsnotachieving90%hasafreeschoolentitlementof30%+.ItiscurrentlyanExtendedSchoolwithanurseryclass.Itbelowitsintaketarget

KeyStage2Level2English

8 6 4oftheschoolsnotachieving90%haveafreeschoolentitlementof30%+,allofwhicharecurrentlyExtendedSchools,twoofwhichhaveanurseryclassandoneareceptionclass.Twoarebelowtheirtargetintake.

KeyStage2Level2Maths

8 7 4oftheschoolsnotachieving90%haveafreeschoolentitlementof30%+,allofwhicharecurrentlyExtendedSchools,twoofwhichhaveanurseryclassandoneareceptionclass.Twoarebelowtheirtargetintake.

1 FromKeyStageOne&TwoAssessmentsforschoolsintheLisburnAreain2010/11–DepartmentofEducation

2 The2012/13ExtendedSchoolentitlementwillbedeterminedpriortoSeptember2012.

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TheseprimaryschoolKeyStage1&2findingswouldsuggestseriousconcernsabouttheStage1resultsinfiveoftheprimaryschools(fiveinEnglishandthreeinMaths)andKeyStage2resultsinsevenprimaryschoolsinbothEnglishandMaths.Surprisingly,fouroftheseschoolshavelessthan20%ofpupilsentitledtofreeschoolmeals.

Twooftheprimaryschoolslistedsend70%+oftheirpupilstoagrammarschool.Fiveprimaryschools(includingtheabovetwo)sendmorethanhalfoftheirpupilstoagrammarschool.Sixoftheschoolssent20%orlessoftheirpupilstoagrammarschool.ThefindingsalsoshowthatgoodresultsatKeyStage1donotnecessarilymeangoodresultsatKeyStage2andvisa-versa.

Thesestatisticsonprimaryschoolperformanceareveryinteresting,becausethereisaweakerlinkbetweentheassessmentscoresandthepercentageofpupilsentitledtofreeschoolmeals(ameasureofdeprivation)thantheliteraturewouldsuggest.Thisimpliesthat,inadditiontotheroleofparents,theroleoftheschoolisveryimportantinincreasingtheaspirationsandachievementofchildren.

Byward,thenumbers(notpercentage)ofpupilswhoareresidentinthetargetareasandattendagrammarschoolareasfollows:

Bywayofcontrast,thefigureforWallaceParkis175andthefigureforPoleglassis125.

Theresultssuggestthat,onaverage,atKeyStage2,aboutonequarterofpupilsinLisburnExtendedSchoolsarenotachievingtheminimumacceptablestandardatKeyStage2EnglishorMaths.However,theactualpercentagevariesbetweenschoolsandsubjects:from19.45%to53.55%.These25%ofprimaryschoolpupils(andtheworstperformingschools)shouldbeanimportantfocusofanyEarlyInterventioninitiativeandthegenerationswhicharelikelytofollowintheirfootsteps,unlessdecisiveactionistaken.

0 10 20 30 40 50 60 70 80 90 100

Knockmore

Hillhall

Lambeg

Lagan Valley

Tonagh

Hilden

Old Warren 21

31

36

59

68

72

88

CHAPTER TWO


Page 19

Theseprimaryschoolresultswouldsuggest,subjecttotheoutcomeoftheauditofschoolsthatiscurrentlytakingplace,whichmayresultinfurtherschoolclosures,anyprimaryschoolsinitiativeshould,perhaps,beconcentratedontheschoolsdesignatedasExtendedSchools(3ofwhichhavenurseryclassesand1whichhasareceptionclass),oronthefouroftheExtendedSchoolswiththelowestkeystageresults(twooftheExtendedSchoolshaveimpressiveKeyStage1&2results).

TheevaluationoftheExtendedSchoolprogrammedidnotdemonstratearelationshipbetweenExtendedSchoolfundingandPrimarySchoolperformance,butrecommendedacloserrelationshipbetweentheactivitiesfundedundertheExtendedSchoolprogrammeandtheeducationalaimsoftheschool.

Post-PrimaryPerformance

Percentageofpoorattendance(lessthan85%)atpost-primaryschoolAllthetargetwardsinLisburnareworsethantheNIaverageof12.7%fornotachieving85%attendanceatpost-primaryschools:

0 10 20 30 40 50 60 70 80 90 100

Knockmore

Hillhall

Hilden

Lagan Valley

Tonagh

Old Warren

NI average 12.7%

30.0%

25.6%

25.1%

23.7%

21.2%

20.3%

Page 20

Leavingschoolwith5+GCSEsatgradeA*-C(2009/10)*AllthetargetwardsareconsistentlywellbelowtheNIaverageof72%foryoungpeopleleavingschoolwithatleast5GCSEsatgradeA*toC,includingthemoreaffluentLambegward:

AveragenumberofpupilsleavingcontrolledandintegratedschoolsinLisburnin2010/11with5+GCSEs(DeptofEducation)

Average and Range 2010/11

Comment

%ofcontrolledandintegratedsecondaryschoolpupilsinIisburnachieving5+GCSEsA*-CwithEnglishandMaths(2010/11)

Average:24.27%

Range:19.6–26.7%

TheaverageforallNIschoolsis60%.(and36%forallNInon-grammarschools).TheNIgovernment’sPfGtargetisanaverageof66%forallpupilsand49%fordisadvantagedpupilsby2014/15

%ofcontrolledandintegratedsecondaryschoolpupilsinLisburnachieving5+GCSEsA*-C(2010/11)

Average:44.57%

Range:43.5–46.4%

TheaverageforallLisburnschoolsis75.1%.(96.8%forLisburngrammarschools)Theaveragefornon-grammarschoolsinNorthernIrelandis57.3%.

OneoftheLisburnsecondaryschoolscurrentlyhasExtendedSchoolsfunding.Anotherhadthefundingunderapreviousround.TwoofthesecondaryschoolsarecurrentsubjecttoFormalIntervention.

0 10 20 30 40 50 60 70 80 90 100

Knockmore

Hilden

Hillhall

Lagan Valley

Lambeg

Old Warren

Tonagh

NI average 12.7%

20%

40%

48%

53.1%

55%

57%

58%

* NINISwardandSOAprofiles(www.ninis.nisra.gov.uk–lastupdatedOctober2011)

CHAPTER TWO


Page 21

Leavingschoolwith2ormoreAlevelsAllthetargetwardsareconsistentlylowerthantheNIaverageof53.6%foryoungpeopleleavingschoolwith2ormoreAlevels(56%inLisburn).EventhemoreaffluentLambegWardhasapoorrecordintermsofAlevelresults:

A level results of post-primary schools TheNIaverageforallpost-primaryschoolsAlevelresultsin2010/11is51.5%leavingschoolwith3+AlevelsA*-C(DepartmentofEducation).TheaverageforthesecondaryschoolsinLisburnis35.1%(48.4%achieved5+GCSEs).

Percentageofschoolleaversinhighereducation*AllthetargetwardsareworsethantheNIaverageof42%foryoungpeoplegoingontohighereducationi.e.university:

TheNIaverageforyoungpeopleleavingnon-grammarschoolsandgoingontouniversityorequivalentis19.2%.TheNIaverageforyoungpeopleentitledtofreeschoolmealsgoingontouniversityorequivalentis18.3%.Againboystendtodomuchworsethangirls.

0 10 20 30 40 50 60 70 80 90 100

Knockmore

Hillhall

Lagan Valley

Hilden

Tonagh

Lambeg

Old Warren

NI average 53.6% Lisburn average 56%

12%

14%

20%

32%

34%

38%

44%

0 10 20 30 40 50 60 70 80 90 100

Knockmore

Hilden

Tonagh

Old Warren

Hillhall

Lagan Valley

NI average 42%

9.4%

10%

12%

20%

29%

30%


Page 22

Percentageofschoolleaversinfurthereducation*AllthetargetwardsareworsethantheNIaverageof33%(andtheNInon-grammaraverageof43.7%)foryoungpeoplegoingontofurthereducation(i.e.college):

Education,skills&trainingdeprivationdomainrankingforSOAs*TheoverallNINIS2010education,skills&trainingrankingsforallthetargetSOAsareasaremuchworsethantheiroverallmultipledeprivationranking.Someofthedifferencesarestriking.

CommunityConsultationsThefindings,above,fromthestatisticsoneducationalachievement,wereechoedbythefindingsfromthecommunityconsultations.Muchofthediscussionaroundeducationalunderachievementhighlightedaviciouscircleinvolving:

0 10 20 30 40 50 60 70 80 90 100

Hillhall

Knockmore

Lagan Valley

Tonagh

Old Warren

Hilden

NI average 33%

11%

12%

20%

25%

30%

31%

0 100 200 300 400 500 600 700 800 900 1000Hillhall 2

Knockmore 1

Knockmore 2

Laganvalley 1

Tonagh

Hilden 1

Hillhall 1

Hilden 2

Old Warren 5995109

128134

173181

393512

within the worst 10% of SOAs (MDM ranking of 85)







(MDM ranking of 550)

(MDM ranking of 612)


CHAPTER TWO


Page 23

■ parentswhooftenthemselveshadpoorexperiencesintheeducationsystemandthereforedonotvalueeducation;

■ povertyrestrictingtheabilityofmanyfamiliestoencouragetheirchildrentogotoagrammarschool,getextratuitionwhentheyneedit,and/orgoontouniversityinsteadofgettingajob;

■ parentsfacingoverwhelmingpersonaldifficulties(mentalhealth,physicalhealth,carerresponsibilities,addiction,domesticviolence,etc)themselves;

■ parentshavinglowambitionsforthemselvesandtheirchildren;■ parentswithpoorliteracyandnumeracy;■ parentsnotreadingtotheirchildren;■ thetendencyofchildrentofollowinthefootstepsoftheirparents,older

siblingsand/orfriends,includingthosewhohavelesspotential;■ lackofconsistentboundariessetforchildrene.g.lettingchildrenstayuplate

andarelateortiredthenextdayinschool,ornotensuringthechildrenattendschool;

■ lackofconsistentpositivediscipline,orveryharshdiscipline,leadingtopoorbehaviour/conduct;

■ lackoffocusedsupportforchildrenwithlearningdifficulties/developmentdelay,butnotstatemented;

■ thelackofcommunityrolemodelschampioningtheimportanceofeducation;■ thelackofavailablejobswhichcouldcreateamotivatortoobtain

qualifications;■ lackofparentalengagementwithschoolsparticularlyafterP1&P2;and■ parentsandteachersviewingmanychildrenas“notacademic”andtreating

themaccordingly(incontrasttomiddle-classparentswhowilltendtoseekoutandpayforappropriateprivatetuitionorsupportservice,toensuretheirchildwillfulfilltheirambitions/potential.

Parentsconsultedwhoareworkingtendedtoresenttheprioritygiventoparentsonincomesupportorjobseekersallowanceinobtainingplacesinnurseryschools;aswellasnurseryplacesbeingallocatedtomiddle-classchildrenfromoutsideofthearea.

Theconsultationsalsohighlightedtheparticularchallengesfacedbytheincreasingnumberofloneparents.Oneteacherhighlightedaparticularclassintheirschoolwhichhadnofatherslivingwiththeirchildren.Thevastmajorityofprimaryschoolteachersarealsowomen,raisingconcernsaboutthelackofpositivemalerolemodelsinthelivesofboys.

Page 24

ConsequencesofpooreducationaloutcomesLeavingschoolwithfewornoqualificationshasverysignificantimplicationsfortheoutcomesforthatchildinlaterlife.OfthosewholeftschoolwithnoqualificationsinNorthernIreland,only45%arecurrentlyinanyformofemployment.Thequalificationsgainedalsohaveamajorimpactontheincomeoftheindividual,asshownbythegraphbelow.

WageRatesbyQualificationLevel

Thosewithathird/tertiary(degree)levelqualificationearnedmorethan40%abovetheaverage.Thosewithnoqualificationsearnedonlyc.75%oftheaverageandthereforeareathighriskofpoverty.

CommentoneducationaldisadvantageThesefindingsshowclearlythatonalleducationalindicatorsthemajorityofchildrenandyoungpeopleinthetargetareasarefailingtoachievetheirpotentialintermsofeducationaloutcomes.Evenattendanceatschoolisasignificantproblem,rightfromprimaryschool(andmuchworseatpost-primary).Outcomesintermsofgoingontoagrammarschool,achievingGCSEs,AlevelsandgoingontocollegeoruniversityareverysignificantlylowerthantheNIaverage.

Theextentofeducationaldisadvantageismuchworsethanwouldbeanticipatedfromthedataoneconomicdisadvantage(seeabove)aloneandcomparespoorlywithothermoreeconomicallydisadvantagedpredominantlyCatholic/Republicanareas.

0%

20%

40%

60%

80%

100%

120%

140%

160%

180%

2011201020092008200720062005

Tertiary A-level No Quals

CHAPTER TWO


Page 25

IftheevidenceinrelationtogenderforNorthernIrelandasawholeisthesameinLisburn,itisalsolikelythatboysinLisburnareperformingmorepoorlythangirls.

ThesefindingsareconsistentwiththefindingsofthePWCNI-widestudycommissionedbytheDepartmentofEducationin2008,whichshowedthatatKeyStage2EnglishandMathematics,proportionatelyfourtimesasmanycontrolledschoolswereunderperforminginNIcomparedtomaintainedschools.AtGCSEEnglishandMathematics,14%ofcontrolledschoolsinNIwereunderperforming,comparedwith4%ofmaintainedschools.TheyalsosupporttheconclusionsofthePurvisReviewinrelationtounder-achievementofProtestantworking-classchildren.

Itiscommonforschoolstobeblamedforthisunder-achievement.However,theresearchevidenceshowsthat75-90%ofthedifferencebetweenchildrenwhoachieveandunder-achieveisduetofactorsoutsideofthecontrolofschools,particularlyinrelationtoparentswhothemselveshaveunder-achievededucationallyand,asaresult,donotvalueeducation.

2.4Health&WellbeingThissectionlooksatsomeofthemeasurableindicatorsofhealthwithinthetargetdisadvantagedcommunitiesinLisburnandtheviewsofthoseinvolvedinthecommunityconsultations.

Dentalregistrationsofyoungchildren1Thelevelsofdentalregistrationsof0-2and3-5yearoldsin2011areconsistentlylowerthantheNIaverage(27.8%for0-2yearoldsand63.6%for3-5yearolds)inallthetargetareas,exceptfor0-2yearoldsinHillhall.

Ward Dental registrations of 0-2 year olds

Dental registrations of 3-5 year olds

Comment

OldWarren 19.6% 43.2% 68%and70%respectivelyoftheaverage

LaganValley 17.9% 46.7% 64%and73%respectivelyoftheaverage

Tonagh 21.6% 40.2% 78%and63%respectivelyoftheaverage

Hilden 24.8% 49.5% 89%and78%respectivelyoftheaverage

Knockmore 24.4% 54.3% 88%and85%respectivelyoftheaverage

Hillhall 27.9% 51.8% ThesameastheNIaveragefor0-2yearoldsbutonly81%oftheaveragefor3-5yearolds

NIAverage 27.8% 63.6%

1 DentalRegistrations2011CSA

Page 26

SmokingduringpregnancyMothersinmostofthetargetareasaremuchmorelikelytosmokeduringpregnancythantheNIaverageof16%:

Percentageofbirthstounmarriedmothers2

MostofthetargetareasaresubstantiallyabovetheNIaverageof39.8%forthepercentageofbirthstounmarriedmothersin2009,exceptforKnockmore1.TheSOAswiththehighest%ofbirthstounmarriedmothersareOldWarren,LaganValley1andHillhall1.

0 10 20 30 40 50 60 70 80 90 100

Hillhall

Hilden

Lagan Valley

Tonagh

Knockmore

Old Warren

NI average 16%

34%

29%

25%

24%

19%

16%

(more than twice the NI average)

(87% above the NI average)


(50% above average)


Hillhall is the same as the NI average

0 10 20 30 40 50 60 70 80 90 100

Knockmore 2Knockmore 1

KnockmoreHillhall 2Hillhall 1

HillhallTonagh

Hilden 2Hilden 1

HildenLagan Valley 1

Old Warren 72.5%63.2%

52.9%55.6%

50%48.7%

43.5%60.9%

26.1%33%

29.2%42.3%


(58.8% above the NI average)







(below the NI average)




2 NINISwardandSOAprofiles(www.ninis.nisra.gov.uk–lastupdatedOctober2011)

CHAPTER TWO


Page 27

Medianageofmothersofnew-bornbabies(notavailablebySOA)TheNIaverageageformothersofnew-bornbabiesis29.TheaverageinOldWarren,HillhallandHildenisyoungerthantheNIaverage.

LifeExpectancyLifeexpectancy(seemedianageatdeath,below)isbelowtheNIaverageforbothmenandwomeninOldWarrenandTonagh.ItisalsobelowtheNIaverageformeninHillhallandforwomeninKnockmore.

Medianageatdeath(notavailablebySOA)MostofthetargetwardshaveanaveragelifespanbelowtheNIaverageof79.OfparticularconcernisOldWarrenwherethedifferenceis6years.

0 10 20 30 40 50 60 70 80 90 100

Tonagh

Knockmore

Lagan Valley

Hilden

Hillhall

Old Warren

NI average 29

26

27

27

27

29

30

(3 years below the NI average)


(2 years younger than the NI average)


(same as the NI average)

(1 year older than the NI average)

0 10 20 30 40 50 60 70 80 90 100

Lagan Valley

Knockmore

Hilden

Tonagh

Hillhall

Old Warren

NI average 79

73

77

78

78

81

82



(1 year below the NI average)

(1 year below the NI average)

(above the NI average)

(above the NI average)

Page 28

Percentagedeathsunderage75*OldWarrenandKnockmore2arewellabovetheNIaverageof38.4%forthepercentageofdeathsin2009forpeopleundertheageof75.

CommunityConsultationsThecommunityconsultationsalsohighlightedarangeofphysical,mentalandsexualhealthrelatedissuesofconcern,which,intheresearchliterature,areoftenassociatedwithgeographicalareasofsignificantdisadvantage.Theseinter-relatedissuesincludethefollowing:

■ Smoking(includingsmokingduringpregnancy)■ Heavydrinking(includingdrinkingduringpregnancy)■ Druguse,especiallyprescriptiondrugs■ Depressionandothermentalhealthdifficulties■ Self-harmandsuicide■ Unhealthyeating■ Obesity■ Lackofexercise

CommentsonhealthandwellbeingissuesThestatisticsandcommunityconsultationsraisesignificantconcernsabouthealthandwellbeingissuesinthetargetareas.ThelevelofearlydeathinOldWarrenandKnockmore2isparticularlydisturbing.Thefactthatthemajorityofbirthsaretounmarriedmothersreflectschangesinsociety,butismuchhigherthanotherpartsofNorthernIreland(andLisburn).Itreinforcestheevidencefromschoolsofthehighlevelofloneparents,whichcanhavesignificantimplicationsforparenting.Thehighlevelofsmokingduringpregnancyisonecontributing

0 10 20 30 40 50 60 70 80 90 100

Lagan Valley 1Lagan Valley

Hilden 2Hilden 1

HildenKnockmore 2Knockmore 1

KnockmoreTonagh

Hillhall 2Hillhall 1

HillhallOld Warren 52%

37.5%36.4%

40%

35%38.5%

27%20%

57.1%26.1%

15.4%17.5%

41.7%


(just below the NI average)

(just below the NI average)

(the same as the NI average)


(70% of the NI average)

(half the NI average)

(almost 50% above the NI average)

(two-thirds of the NI average)


(40% below the NI average)

(less than half the NI average)

(9% above average)


CHAPTER TWO


Page 29

factortopassingondisadvantagetothenextgeneration.Thelevelofdentalregistrationsisafurtherindicationofsomeparents’knowledgeorlackofconcernforthehealthandwellbeingoftheirchildren.

2.5SafetyandStabilityThissectionexploresissuesofsafetyandstabilityindisadvantagedcommunitiesinLisburn,includingprotectionofchildren,anti-socialbehaviourandcrime.

ChildProtectionThefollowingtableshowsthenumberofchildrenwhowerereferredtosocialservicesinrelationtochildprotectionissueslastyearand,aschildrenmoveinandoutoftheChildProtectionRegisterovertime,thenumberofchildrenwhoarecurrentlyonthechildprotectionregisterineachofthetargetSOAs:

SOA Number of children referred (2011)

Number of children currently on the child protection register (a

particular point in time in 2012)Derryaghy1 113(the2ndhighestSOAin

theSEHSCTarea)10

OldWarren 78 15

Tonagh 53 18(thehighestofanySOAintheSEHSCTarea

Hilden1 34 *

Hilhall1 33 10

LaganValley1 30 7

LaganValley2 27 *

Hilden2 5 *

*Lessthan5

ThesestatisticssuggestparticularchildprotectionconcernsinDerryaghy1,OldWarren,TonaghandHillhall1.

Page 30

Numberofanti-socialbehaviourincidentsAllthetargetwardsarewellabovetheNIaverageof141forthenumberofanti-socialbehaviourincidentsreported,exceptforHillhall(91):

Numberofcriminaloffencesper10,000ofthepopulation(2010/11)1

AllthetargetwardsarewellabovetheNIaverageforcrime,exceptforHillhallandKnockmore.ViolentcrimesaremorethantwicetheNIaverageinHildenandTonagh.

Violent crimes

Criminal damage

Burglary Other theft offences

Vehicle offences

Totals

Hilden 502.4 303.6 150 376.8 41.9 1573.6

Tonagh 477 278.9 32.3 319.3 68.7 1321.7

Laganvalley 310 330 73.3 190 40 1126.7

OldWarren 252.5 332.7 80.2 64.1 36.1 853.7

Hillhall 126.6 94 32.5 94 36.2 470.2

Knockmore 110 107.7 60.9 67.9 70.2 461.1

NIaverage 165.6 138.9 65.9 102.8 38.5 583.8

0 100 200 300 400 500 600 700 800 900 1000

Hillhall

Knockmore

Old Warren

Laganvalley

Hilden

Tonagh

NI average 141

(two and a third times the NI average)

(two and a third times the NI average)

(two and a quarter times the NI average)

(one and a half times the NI average)

(a third above the NI average)

(below average)

331

330

316

220

190

91

1 NINISwardandSOAprofiles(www.ninis.nisra.gov.uk–lastupdatedOctober2011)

CHAPTER TWO


Page 31

NumberofdomesticabuseoffencesAllthetargetwardsareabovetheNIaverageof17forthenumberofdomesticabusecasesreportedin2010:

CommunityConsultationsTheconsultationswithlocalcommunities,schoolsandprofessionalsworkinginthearea,alsohighlightedconcernsinrelationtosafetyandstability,inparticular:■ youngpeopleengaginginanti-socialbehaviourandcriminalactivity,

includingviolence■ domesticviolence

However,insomeareastherealsoseemstohavebeenimportantimprovementsinrelationshipswiththepoliceinstartingtotrytotacklesomeoftheseissues.

CommentsonsafetyandstabilityThestatisticsfromthetargetareasreflectverysignificantconcernsaboutchildprotectionissues,anti-socialbehaviourandcrime,includingdomesticviolence,inmanyofthetargetareas,whichwerereinforcedduringthecommunityconsultations.

2.6ParentingAkeyunderlyingissueinallthecommunityconsultationswasamajorconcernaboutparenting,which,initself,hasanimpactontheotherissueshighlightedaboveof:educationalunder-achievement;lackofambition;unhealthylifestyles,etc.ensuringthatthecycleofdisadvantageandunder-achievementispassedongenerationtogeneration.

Parentingissuesarehardertoquantifyinstatisticalinformationandcanoftenonlybequantifiedindirectlye.g.throughissueslikethelevelofdental

0 10 20 30 40 50 60 70 80 90 100

Hillhall

Laganvalley

Knockmore

Hilden

Tonagh

Old Warren

NI average 17

36

36

34

33

32

20



(twice the NI average)

(twice the NI average)



Page 32

registrations(highlightedunder“health”above),childaccidentsorhospitaladmissions,orchildrenontheriskregister,orincare.

However,parentingcameupasthemajorthemeinnearlyallthecommunityconsultations.Someofthekeyissueshighlightedintheconsultationswereasfollows:

■ Havingchildrenwhentheparentsweretooyoung■ Parentingskillsnolongerpasseddownthroughthegenerations■ Lackofparentingknowledge■ Lackofaparentingculture■ Lackofownershipoftheeducationanddevelopmentoftheirchildren(theyare

perceivedasotherpeople’sresponsibilities)■ Lackofambitionfortheirchildren■ Wanttobetheirchildren’sfriends–lackofdiscipline■ Lackofengagementoffathers■ Lackofmalerolemodels

Otherissuesparticularlyconcernedwithparentingandhealth,alreadyhighlightedabove,wereasfollows:■ Feedingtheirchildrenunhealthyfood■ Obesity■ Smokinganddrinking■ Exercise■ Mentalhealthissuesforparentsaffectingthechildren■ Medicalproblemsforparentsaffectingthechildren

Otherissuesconcernedprimarilywithparentingandeducation,alreadyhighlightedabove,wereasfollows:■ Badexperienceofeducationthemselves■ Notreadingtotheirchildren■ Parentsnotstakeholdersinoureducationsystem■ Notengagingenoughwithschool■ ParentsonlyinterestedinbeinginvolvedinP1&P2andloseinterestafterthat■ Nothelpingchildrenwiththeirhomework■ Lackofambitionorexpectationfortheirchildren■ Childrenbeingallowedtostayuplate–childrentiredandlatethenext

morning■ Thereareparentswhoinotherwaysaregoodparentsbutdon’tvalue

education■ Poordisciplineathomeleadingtoconductproblemsatschool

CHAPTER TWO


Page 33

2.7ProvisionforChildrenandYoungPeople

OldWarrenThereisoneplaygroup(asatelliteoftheColinSurestart)inOldWarren,withamorningcrèchefor10children,whiletheirparentsparticipateinaprogrammeandanafternoonprogrammefor2yearolds.

RaggedyBapplaygroupforchildrenaged2yearsand10months,inaformerNIHEhouseinAvonmoreParkOldWarren,ismanagedbyOldWarrenCommunityAssociation.Therearemorningandafternoonsessions.RaggedyBapisamemberofEarlyYears.

OldWarrenPrimarySchoolhasaNurseryClass.

KnockmoreThereisaplaygroupeachmorninginGroveActivityCentreforchildrenbetween2yearsand10monthsto4yearsold.StAloysiusPrimarySchoolinKnockmoreestate(OldWarrenward)hasanurseryclass.

TonaghTonaghPrimarySchoolhasareceptionclass.ThereisamotherandtoddlersgroupinachurchhallinTonagh.ThereisacrècheinStColumbasPresbyterian-MethodistChurch.

HilhallTheColinSureStarthasanoutreachprogrammebasedinanoldshopunitinHillhall,butwillbemovingintoanewcommunityfacility.Thereisanursery(BarbourNursery)inHilhallEstate.Localresidentshaveconcernsaboutthecriteriaforprioritizingadmissiontothenurserywhich,intheirview,favoursthechildrenofmiddle-classfamiliesfromoutsidethearea,andtheunemployedfromwithinthearea.ThereisalsoastatutorynurseryinLargymorePrimarySchool.

HildenBarnardosrunaParentInfantProgrammeinHilden.ThereisamothersandtoddlersagroupmintheGospelHall.After-schoolsprogrammesareruninthecommunityhousefor5-11,12-18and14/15yearolds.SomeyoungpeopletendtheFusionYouthProgrammeinLisburnCathedral.

LaganValleyInLaganValleythereisoneplaygroup,1daynursery(intheHospital)and1After-schoolclub.

Page 34

BallymacashThereisaplaygroupinBallymacashPrimarySchool(memberofEarlyYears)andanurseryclassinKillowenPrimarySchool.

Incontrasttotheaboveprovision,thereare3playgroups,1after-schoolscluband1crecheinWallacePark;3playgroupsinTwinbrook;and3creches,2daynurseriesand1after-schoolsclubinPoleglass.

YouthWorkSEELBisfundingaqualifiedyouthworkertoprovide6contactsessionswithyoungpeopleinOldWarren,throughOldWarrenYouthInitiativesandStreetsAhead(inOldWarren,HillhallandHilden).TheStreetsAheadfundingendsin18months.

AqualifiedyouthworkerisalsofundedbytheBoardtoprovide6hoursyouthworkinOldWarrenand6hoursinHillhall.TheBoardalsofundsasecond6houryouthoutreachpostinHillhallandoneinHilden.

SEELBisalsofundingfullandpart-timeyouthworkersintheYMCAincentralLisburn.TheBoardYouthServicehasaskedthemtofocusonKnockmore.

Thereisafull-timeyouthcentreaspartofLaurelhillCommunityCollege,withamaincatchmentareaofKnockmoreandBallymacash,plusLaurelhillschoolstudentsfromotherareas.

FollowingtheclosureofDerriaghyPrimarySchool,thesiteisbeingturnedintoayouthandcommunityfacility,withafull-timeyouthworker.

SEELByouthworkersdelivertheschool-based“NewBeginnings”programmefornewyear1pupils.

ManychurchesareinvolvedinyouthworkinLisburn.SixLisburnchurcheshavefull-timeyouthworkers.LisburnYMCA,inadditionto1.1familyworkandwrap-aroundsupport,providesyouthprovisionincentralLisburnfournightsandoneafternoonaweek,inadditiontoworkwithyoungpeopleatriskofschoolexclusion,inpost-primaryschools;analcoholprogrammeinpost-primaryschools;adviceonsexualandmentalhealth;andtrainingandemploymentforNEETS.

TheDepartmentofEducationplantoissuethelong-awaited“PrioritiesforYouth”draftyouthworkstrategyforNorthernIrelandbeforethesummer2012.

CHAPTER TWO


Page 35

2.8ConclusionsinrelationtoindicatorsofneedinthetargetcommunitiesinLisburn

Thestatisticsinrelationtoneedsinthetargetcommunities,insomerespects,showapatternthatiscommontomanyworkingclasscommunitiesandconfirmedbymanyresearchstudies,withlowincomes;dependenceonbenefits;youngunmarriedmothers;smokingduringpregnancy;emotionalandmentalhealthdifficulties;anddifficultieswithanti-socialbehaviourandcrime,includingdomesticviolence.

Thefindingsthatarebothshockingandunexpectedfromanacademicperspective,aretheverypooreducationaloutcomesofaverysignificantnumberofchildrenandyoungpeople,thevastmajorityofwhomdonotevenachieve5GCSEswithEnglishandMaths,andthereforedonotachieveAlevelsorgoontheuniversityorcollege.Concernsaboutattendanceatschoolandunder-achievementareevidentfromprimaryschoolonwards.

Cycleofdeprivationandunder-achievementThesefindings,inadditiontotheviewsexpressedduringtheconsultationswithcommunitiesandprofessionalsinthetargetareas,suggestaviciouscycleofdeprivationandunder-achievement,that,astheliteraturewouldsuggest,ispasseddownthroughthegenerationsandwhichisnotbrokenbythecurrentsetofagencies,servicesandprogrammesworkingintheareas.Thiscyclepresentsmajorchallengesintryingtobringaboutchange.Intermsofinterventions,discussedlater,itispossibletoattempttointerveneatanypointinthecycle.

Page 36

CycleofDeprivationandUnder-Achievement

Difficult transition to nearest secondary school; poor nutrition; poor numeracy and literacy; low aspirations; behavioural problems; poor attendance at school; poor test results; lack of parental engagement with the school or homework; anti-social behaviour; drinking; smoking; early sexual experiences.

Poor nutrition; poor numeracy and literacy; low aspirations; behavioural problems; poor attendance at school; poor test results; lack of parental engagement with the school or homework; poor transfer test results or not entered in transfer test.

Educational under-achievement (leave school early with few or no

qualifications); unemployed or in low paid employment; low aspirations; poor

relationships with parents; anti-social behaviour and/or crime; engagement

with the criminal justice system; risky sexual experiences – multiple

partners; increasing experience of alcohol and drugs;

teenage/unplanned pregnancy; smoking

and/or drinking during pregnancy.

Lack of breast-feeding;

poor parenting; poor infant brain

development; poor parental attachment; parents

not talking to, playing with, or reading to children; lack of

boundaries established; behavioural problems; poor early

cognitive abilities; parents experiencing mental health difficulties

and/or problems with alcohol and/or drugs (including prescription drugs); children not ready for primary school.

AGE 11-14

AGE 5-11

AGE 14-18

AGE 0-4

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3.1IntroductionTheCentreforExcellenceandOutcomesforChildrenandYoungPeople(CE04)definesEarlyInterventionas“interveningearlyandassoonaspossibletotackleproblemsemergingforchildren,youngpeopleandtheirfamiliesorwithapopulationatriskofdevelopingproblems.Earlyinterventionmayoccuratanypointinachild’slife”(GraspingtheNettle’Report2009).Anearlyinterventionapproachsuggestsinterventions:

■ intheearlyyearsofachild’slife,where,theevidencesuggests,manyproblemsinlaterlifearecreatedandatwhichstagebraindevelopmentismoulded;

■ attheearlystageofdifficulty,whenachildmaybevulnerabletopoordevelopmentaloutcomes;

■ basedonwholesocietyapproachtoearlyinterventionthroughanetworkofsupportsandservicesandmulti-agencyworking;

■ whichareevidence-basedthroughrigorousevaluation(eitheradoptingevidence-basedprogrammeswhichhavepreviouslybeenrigorouslyevaluated,orinnovatingevidence-informedprogrammeswhicharethenrobustlyevaluated;

■ arefocusedonclearlymeasurableoutcomes;■ supportingandempoweringparents,familiesandinformalsupportnetworks;■ whicharelong-term/sustainable(notshort-termfundedprojectswhichend

whenthefundingends);■ whichcombineuniversal(allchildren)preventionprogrammesandnon-

stigmatisingtargetedearlyinterventiononthosemostatrisk;■ areaccessibleandflexible;and■ promoteparticipationandinclusion.

3.2WhyisEarlyInterventionImportant?Theinternationalevidencefromaverywiderangeofsourcesanddisciplinesisallpointingtowardsthecrucialimportanceofearlyinterventionintacklingdisadvantageandunder-achievement.Themainreasonsareasfollows:

■ Aseriesofnationalandinternationalstudieshaveshownthatproblemsinchildrenasyoungasthreecanpredictmoreseriousproblemsintheteenageyearsandtwenties.

■ Agapincapabilitiesofachildagedthreeyearsoldfromalowsocio-economicgroup,comparedwithonefromahighsocio-economicgroup,willtendtoincreasecontinuallythroughoutthechild’sschoolyears.

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Why early intervention

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■ Brainstudieshaveshownthatthemajorityofthedevelopmentofthehumanbraintakesplaceinthefirstthreeyears.Howthebraindevelopshashugeimplicationsforthedevelopmentofthechild.

■ Itismorecost-effectivetointerveneatayoungage.NobeleconomistJimHeckmanhasshownthatresourcesinvestedintheearlyyears(0-4)islikelyonaveragetoresultinseventimesthatamountinthelaterlifeofthechildintermsofreducedmentalhealthcosts,justicesystemcosts,etc.

3.3TheLinkbetweenPovertyandEducationalDisadvantageintheUKIn2010theJosephRowntreeFoundationpublishedastudyofchildren’seducationalattainment(AlisaGoodmanandPaulGregg26March2010),basedonfourlarge-scalelongitudinalsourcesofdataonchildrengrowingupintheUKtoday.TheseweretheMillenniumCohortStudy(UK-wide),theAvonLongitudinalstudyofParentsandChildren,theLongitudinalStudyofYoungPeopleinEnglandandtheChildrenoftheBritishCohortStudy.Thechildreninthesestudiesrangedfromearlychildhoodthroughtolateadolescence.

Theresearchshowedthateducationaldeficitsemergeearlyinchildren’slives,evenbeforeentryintoschool,andwidenthroughoutchildhood.Evenbytheageofthreethereisaconsiderablegapincognitivetestscoresbetweenchildreninthepoorestfifthofthepopulationcomparedwiththosefrombetter-offbackgrounds.Thisgapwidensaschildrenenterandmovethroughtheschoolingsystem,especiallyduringprimaryschoolyears.

AnalysisoftheMillenniumCohortStudyshowedbigdifferencesincognitivedevelopmentbetweenchildrenfromrichandpoorbackgroundsattheageofthree,andthisgapwidenedbyagefive.Thereweresimilarlylargegapsinyoungchildren’ssocialandemotionalwell-beingattheseages.Childrenfrompoorerbackgroundsalsofacedmuchlessadvantageous‘earlychildhoodcaringenvironments’thanchildrenfrombetter-offfamilies.Forexample,comparedwithchildrenfrombetter-offbackgrounds,thereweresignificantdifferencesinpoorerchildren’sandtheirmothers’:

■ healthandwell-being(e.g.birth-weight,breastfeeding,andmaternaldepression);

■ familyinteractions(e.g.mother–childcloseness);■ thehomelearningenvironment(e.g.readingregularlytothechild);and■ parentingstylesandrules(e.g.regularbed-timesandmeal-times).

Differencesinthehomelearningenvironment,particularlyattheageofthree,haveanimportantroletoplayinexplainingwhychildrenfrompoorerbackgroundshave

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lowertestscoresthanchildrenfrombetter-offfamilies.However,alargeproportionofthegapremainsunexplained,orappearsdirectlyrelatedtootheraspectsoffamilybackground(suchasmother’sage,andfamilysize).

Thissuggeststhatpoliciestoimproveparentingskillsandhomelearningenvironmentscannot,ontheirown,eliminatethecognitiveskillsgapbetweenrichandpooryoungchildren.Ontheotherhand,manyaspectsoftheearlychildhoodcaringenvironmentdohaveapositiveeffectonchildren’ssocialandemotionaldevelopmentandresilience,meaningthatpoliciesaimedatimprovinghealth,parentingskillsandthehomelearningenvironmentcouldstillbeveryimportant.

AnalysisoftheAvonLongitudinalStudyofParentsandChildrensuggestedthatthegapinattainmentbetweenchildrenfromthepoorestandrichestbackgrounds,alreadylargeatagefive,grewparticularlyfastduringtheprimaryschoolyears.Byageeleven,onlyaroundthree-quartersofchildrenfromthepoorestfifthoffamiliesreachedtheexpectedlevelatKeyStage2,comparedwith97percentofchildrenfromtherichestfifth.PoorerchildrenwhoperformedwellinKeyStagetestsatagesevenweremorelikelythanbetter-offchildrentofallbehindbyageeleven,andpoorerchildrenwhoperformedbadlyatsevenwerelesslikelytoimprovetheirrankingcomparedwithchildrenfrombetter-offbackgrounds–animportantfactorbehindthewideninggap.

Someofthefactorsthatappeartoexplainthewideninggapduringprimaryschoolare:■ parentalaspirationsforhighereducation;■ howfarparentsandchildrenbelievetheirownactionscanaffecttheirlives

(self-efficacy);and■ children’sbehaviouralproblems,includinglevelsofhyperactivity,conduct

issuesandproblemsrelatingtotheirpeers.

Parentalaspirationsandattitudestoeducationvarystronglybysocio-economicposition,with81percentoftherichestmotherssayingtheyhopedtheirnine-year-oldwouldgotouniversity,comparedwithonly37percentofthepoorestmothers.Suchadverseattitudestoeducationofdisadvantagedmothersareoneofthesinglemostimportantfactorsassociatedwithlowereducationalattainmentatageeleven.Thefindingssuggestthatgovernmentpoliciesaimingtochangemothers’andchildren’sattitudesandbehaviourduringprimaryschoolingcouldbeeffectiveinreducingthegrowthintherich–poorgapthattakesplaceduringthistime.

AnalysisoftheLongitudinalStudyofYoungPeopleinEnglandfoundthatattainmentgapsatageelevenwerealreadylargeandfurtherwideningwasrelativelysmallintheteenyearscomparedwithearlierinchildhood.Bythetime

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youngpeopletaketheirGCSEs,thegapbetweenrichandpoorisverylarge.Forexample,only21percentofthepoorestfifthmanagedtogainfivegoodGCSEs(gradesA*-C,includingEnglishandMaths),comparedwith75percentoftherichestfifth(seethepreviouschapterforsimilarfindingsinNorthernIreland).

Itbecomeshardertoreversepatternsofunder-achievementbytheteenageyearsbuttherearesomewaysthatdisadvantageandpoorschoolresultscontinuetobelinked.Evenaftercontrollingforlong-runfamilybackgroundfactorsandpriorattainment,youngpeoplearemorelikelytodowellatGCSEiftheirparents:■ thinkitlikelythattheyoungpersonwillgoontohighereducation;■ devotematerialresourcestowardseducationincludingprivatetuition,

computerandinternetaccess;■ spendtimesharingfamilymealsandoutings;and■ quarrelwiththeirchildrelativelyinfrequently.

ThestudyalsofoundthatyoungpeoplearemorelikelytodowellatGCSEiftheyoungpersonhim/herself:■ hasagreaterbeliefinhis/herownabilityatschool;■ believesthateventsresultprimarilyfromhis/herownbehaviourandactions;■ findsschoolworthwhile;■ thinksitislikelythathe/shewillapplyto,andgetinto,highereducation;■ avoidsriskybehavioursuchasfrequentsmoking,cannabisuse,anti-social

behaviour,truancy,suspensionandexclusion;and■ doesnotexperiencebullying.

Sinceyoungpeoplegrowingupinpoorfamiliesdolesswellinalltheserespectscomparedwiththoseinbetter-offfamilies,thisprovidessomeexplanationfortheirpoorereducationalattainmentbytheendofcompulsoryschooling.Whileinterveningearlierinchildhoodislikelytobemosteffective,policiesaimedatimprovingattitudesandbehaviouramongteenagerscouldalsohavesomebeneficialeffectsinpreventingchildrenfrompoorbackgroundsfallingyetfurtherbehindduringthesecondaryschoolyears.

TheanalysisofchildrenoftheBritishCohortStudyfoundthatchildren’stestscoreswerelowestwhenpovertyhadpersistedacrossthegenerations,and,attheotherendofthespectrum,highestwhenmaterialadvantagewaslong-lasting.

Parents’cognitiveabilitiesandotherchildhoodcircumstancesplayaveryimportantroleinexplainingthegapbetweenthetestscoresofricherandpoorerchildrentoday.Nearlyone-fifthofthegapintestscoresbetweentherichestandpoorestchildrencouldbeexplainedbyanapparent‘direct’linkbetweenthechildhoodcognitiveabilityofparentsandthatoftheirchildren.Thiswasfound

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evenaftercontrollingforawiderangeofenvironmentalfactors,andaftertakingintoaccountmanyofthechannelsthroughwhichcognitiveabilitymightoperate,suchasparents’subsequenteducationalattainment,adultsocio-economicpositionandattitudestoeducation.Overfour-fifthsofthegapinthetestscoresofricherandpoorerchildren,however,isnotexplainedbythedirectlinkbetweenthecognitiveabilityofparentsandthatoftheirchildren.

Ontheotherhand,whilegoodsocialskillsalsoappearedtobelinkedacrossgenerationsi.e.parenttochild,thesedonotmakeasignificantdirectcontributiontothecurrentgapincognitivetestscoresbetweenrichandpoorchildren.

Therewasalsoastrongintergenerationalcorrelationbetweenawidevarietyofotherattitudesandbehaviours,suchaswhetheraparentreadstotheirchildeveryday,andparentalexpectationsforadvancededucation.Thepassingofsuchtraitsacrossgenerationsalsohelpstoexplainthepersistentdisadvantagethatchildrenfrompoorbackgroundsfaceintheireducationalattainment.

Thesefindingssuggestthatattitudesandbehaviourarepotentiallyimportantlinksbetweensocio-economicdisadvantageandchildren’seducationalattainmentandhaveshowntwomajorareaswherepolicymighthelptoreduceeducationalinequalities.

Parentsandthefamilyhome:■ Improvingthehomelearningenvironmentinpoorerfamilies(e.g.booksand

readingpre-school,computersinteenyears).■ Helpingparentsfrompoorerfamiliestobelievethattheirownactionsand

effortscanleadtohighereducation.■ Raisingfamilies’aspirationsanddesireforadvancededucation,fromprimary

schoolonwards.

Thechild’sownattitudesandbehaviours:■ Reducingchildren’sbehaviouralproblems,andengagementinrisky

behaviours.■ Helpingchildrenfrompoorerfamiliestobelievethattheirownactionsand

effortscanleadtohighereducation.■ Raisingchildren’saspirationsandexpectationsforadvancededucation,from

primaryschoolonwards.

Therehasbeenamarkedshiftingovernmentpolicyemphasisinrecentyearsawayfromanarrowerfocusoneducationaloutcomes,andtowardsthewideremotionalandsocialwell-beingofchildren(atleastinEngland,WalesandScotland).

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However,someoftheareashighlightedbytheJRFstudyabove(GoodmanandGregg2010)arebettercoveredbyexistingpolicyandevidencethanothers.Forexample:

■ Therehasbeenincreasingemphasisonparentingprogrammesandimprovingchildbehaviourintheearlyyearsbeforeschoolingstarts,butmuchlesssointheprimaryschoolyears(andevenlessinsecondary).TheJRFresearch(GoodmanandGregg2010)suggeststhatreachingfamilieswhilechildrenareofschoolagemightcontinuetobeuseful.

■ Intensiveprogrammesthatfocusonhelpingsmallnumbersofchildrenmostinneedtendtohavethestrongestevidencebehindthem.However,educationaldisadvantageaffectsaverylargenumberofchildrenfromlow-incomefamilies,butwithlowerintensitythanthoseattheextreme,anditmaybethatpolicyneedstofocusmoreonthese.

■ Programmestoraiseeducationalaspirations(suchasAimHigherinEnglandandWales)typicallystartinthesecondaryschoolyears,whilethisresearchsuggeststhatsuchinterventionscouldbeworthwhileatayoungerage–forexampleinprimaryschools.

■ Theevidenceonschoolandlocal-basedinterventionstoimproveyoungpeople’ssocialandemotionalskills,behaviour,andparticipationinpositiveactivitiesneedstobestrengthenedthroughrobustevaluation.

■ Educationalbodiesandschoolshaveasignificantroletoplayintacklingmanyoftheissuesraisedhere.Relevantpoliciesarelikelytoincludehowfundsareallocatedtowardspupilsfromthepoorestbackgrounds,andthedirectteachingsupportprovidedtochildrenwhentheystarttofallbehind.Ifsuccessful,thesesuggestedchangesmightatleasthelptopreventchildrenfrompoorbackgroundsfromslippingfurtherbehindtheirbetter-offpeersthroughouttheirschooling,andindeedcouldgosomewaytowardsclosingtherich–poorgap.

ThefindingsoftheJRFstudy(GoodmanandGregg2010)maybeparticularlyimportantintryingtounderstandwhythedataforworkingclassProtestant/LoyalistcommunitiesinLisburn(andNorthernIrelandmoregenerally)showssuchpooreducationaloutcomes,comparedtoevenmoredeprivedCatholic/Republicanareas.Akeyissuemaybeparentalattitudesandaspirations.

TheindependentreportfromDawnPurvisMLA(Purvis2011)suggeststhatitmaybearesultofdifferentattitudestoeducationwithinworkingclassProtestant/

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Loyalistcommunitiesthathistoricallyreliedonchildrenfollowingtheirparentsfootstepsintolarge-scaleindustrialemployment(e.g.linenmills,threadmills,ropeworks,shipyard,aircraftmanufacture,etc),atrade,orthesecurityservices,forwhicheducationalrequirementswerelow.Whilemuchofthesekindsofjobshavegoneandtheroutesintoemploymentarenowbasedonpublicadvertisementswithclearselectioncriteriaincreasinglybasedonqualificationsandexperienceobtained.However,thecultureandattitudesthatexistedinpreviousgenerationsmaybestillinfluencingattitudestowardseducationandaspirationsinProtestant/Loyalistworkingclasscommunities.

3.4AllenReportsWorkinEnglandbyGrahamAllenMPandIanDuncanSmithMPin2008(EarlyIntervention:GoodParents,GreatKids,BetterCitizensAllen&DuncanSmith2008)andGrahamAllenin2011(EarlyIntervention–theNextStepsAllen2011)hashighlightedtheneedforanemphasisonearlyinterventiontomakesurechildrengetthebeststartinlife.Forexample,theirreviewoftheinternationalliteraturefoundthat:

■ Achild’sdevelopmentscoreatjust22monthsofagecanserveasanaccuratepredictorofeducationaloutcomesatage26

■ Boysassessedasbeing“atrisk”bynursesattheageof3were2.5timesaslikelytohavecriminalconvictions(55%forviolentoffences)attheageof21asthosedeemednotatrisk

TheAllenreportshighlighttheinternationalevidencewhichshowsthatbraindevelopmentintheearlyyearsisacriticalfactorinthedevelopmentofchildren.Babiesarebornwithone-quarteroftheirbraindeveloped.Thereisthenveryrapiddevelopmentofthebrain,sothatbytheageofthree,80%oftheirbrainshavebeendeveloped.Duringthiscriticalperiod,neglect,thewrongtypeofparentingorotheradverseexperiencescanhaveaprofoundeffectonhowchildrenareemotionally“wired”,whichwilldeeplyinfluencefutureresponsestoeventsandtheirabilitytoempathisewithotherpeople.

TheAllenreportsdemonstrate,fromtheliterature,thatearlyinterventiontopromotesocialandemotionaldevelopmentcansignificantlyimprovementalandphysicalhealth,educationalattainmentandemploymentopportunitiesandthatitcanalsohelppreventcriminalbehaviour(especiallyviolentbehaviour),drugandalcoholmisuseandteenagepregnancy.

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Allenconcludesthattherightkindofparentingisabiggerinfluenceonchildren’sfuturethanwealth,socialclass,educationoranyothersocialfactorandsoparentsneedtobegiventheinformationandsupportthattheyneedtohelptheirchildren.

Thereportsalsorecommendtheintroductionofearlyinterventionprogrammeswhichhavebeenshowntoworkinimprovingoutcomesforchildren.Helists72ofthemostpromisingearlyinterventionprogrammes,19ofwhichalreadyhaveverysignificantevidencefortheireffectiveness.

Hisreviewoftheliteraturealsodemonstratesthecosteffectivenessofinterveningearlyinachild’slifetotackleasocialproblemasopposedtointerveninglateron.Economicevaluationsofsomeofthemosteffectiveearlyinterventionprogrammeshaveshownthatinvestinginthefirstfewyears(frompregnancy)ofachild’slifecansavemultiplesofthatinvestmentinlatercostsofprison,welfarebenefits,justiceservices,treatmentprogrammes,mentalhealthservices,etc.Ithasbeenshown,forexample,thatLifeSkillsTrainingprogrammescanproducesavingsof25timesthecostoftheprogramme.

ResearchontheConsequencesofChildhoodDisadvantageinNorthernIrelandSullivanetal(2010)publishedaresearchreport*ontheConsequencesofChildhoodDisadvantageinNorthernIrelandatage5,basedontheNIpartoftheUKMillenniumCohortStudy,in2010.Theresearchfoundthat:

■ Health-relatedindicatorsamongparents,suchassmoking,breastfeedingandBMIwerelessfavourableinNIthaninGB

■ Parents’BodyMassIndex(BMI)islinkedtothechild’sBMIandalsotothechild’seducationalandbehaviouralscores

■ Povertyislinkedtoalltheoutcomes.However,cognitiveandeducationaloutcomesaremorestronglystructuredbypovertythanthehealthandbehaviouraloutcomes.Parentaleducationandsocialclassareparticularlypowerfulpredictorsofeducationalandcognitiveoutcomes.Theirimpacthowevercanonlypartiallyaccountedfordespitethelargenumberofpotentialmediatorsincludingrichinformationonparentingpractices

■ Variablesreflectinggoodparentingpractices,regularityandastronghomelearningenvironmentpredictpositivecognitive,educationalandbehaviouraloutcomes.Father’sinvolvementhasexplanatorypowerforcognitiveandeducationaloutcomes

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* Sullivan,A.,Cara,O.,Joshi,H.Ketende,S.andObelenskaya,P.(2010)The Consequences of Childhood Disdvantage in Northern Ireland at Age 5OFMDFM

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■ Parents’longstandingillnessesandmentaldistressarelinkedtopoorercognitive,educationalandbehaviouralassessmentsandgeneralhealthinthechild

3.5ConclusionsinrelationtoEarlyInterventionAlltheevidencefromtheUKandinternationalsourcespointstotheimpactofparents’educationandsocialclassontheoutcomesfortheirchildren.Thegapbetweenchildrenofdifferentbackgroundsisevidenteveninthefirsttwoyearsoflifeandwidenscontinuouslythroughouttheirchildhood.

Theevidencedemonstratesboththeeffectivenessandcost-effectivenessofinterveninginthefirstcoupleofyearsofachild’slife.Thereareconsiderablesavingsforthestateininvestinginearlychildrenratherthantryingtotacklethesocialproblemsthatemergelaterinlife.

Theliteraturealsohighlightstheimportanceofbasinginterventionsonrealevidenceofwhatworks,especiallyevidencegatheredfromwellrunlargescaleRandomControlTrials.

Theresearchonearlyinterventionalsohighlightsvariousotherissues,includingthefollowing:

■ Parents’obesity,physicalillnessandmentalhealthproblemscanhaveasignificantimpactontheoutcomesfortheirchildren.

■ Parentingiscriticaltothedevelopmentofchildrenandyoungpeople.Effortstoimproveparentingneedtostartfrombeforebirthandcontinueinprimaryschool.

■ Interventionsneedtobeprioritizedonthe0-12agegroup,especiallythe0-2yearoldsandtheirparents

■ Increasingeducationalaspirations,sothateducationisvalued,iscriticaltoimprovingeducationalachievement.

■ Programmesthattargetaverysmallnumberofvulnerablefamiliese.g.thosefocusedonchildprotection,missthelargenumberofchildrenindisadvantagedcommunitieswhoarelikelytounderachieveandinturnfacearangeofeconomic,personalandsocialproblems

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CHAPTER FOUR

The Northern Ireland public policy context that supports the need for change

4.1IntroductionThefollowingsectionhighlightssomeofthekeypublicpolicydocumentsthatarehelpingtodrivethechangeinemphasistowardspreventionandearlyintervention.Thesepublicpolicydocumentscomeunderthebroadheadingofpublichealth;children,youngpeopleandfamilies;education;area-basedinitiatives;andtheProgrammeforGovernment.However,itisimportantnottoreinforcethefragmentationofpolicyandservicesthathasdevelopedfromsilothinkinginpolicydevelopment.

Relevantquotesthatspecificallysupportanearlyinterventionapproachareunderlinedbelow.

4.2PublicHealth

InvestingforHealthIn2002theDHSSPSpublisheditsInvestingforHealthstrategywhichrecognisesthathealthandwellbeingarecruciallydeterminedbythesocial,economic,physicalandculturalenvironmentandseekstoshifttheemphasisfromaconcentrationonthemedicaltreatmentofill-healthtowardstacklingthefactorswhichadverselyaffecthealthandperpetuatehealthinequalities.Thestrategyhighlightstheconsistentinternationalevidencethatthelowerthesocio-economiccircumstancesoffamilies,theworsethehealthandwellbeingofmembersofthefamilyarelikelytobe.Itstatesthat“investinginthecrucialearlyyearsandeducationcanbreakthecycleofdeprivation”.

Thestrategysetouttwooverarchinggoals:■ Toimprovethehealthofourpeoplebyincreasingthelengthoftheirlives

andincreasingthenumberofyearstheyspendfreefromdisease,illnessanddisability

■ Toreduceinequalitiesinhealthbetweengeographicareas,socio-economicandminoritygroups

Italsoestablishedanumberofobjectivesincluding:■ Toreducepovertyinfamilieswithchildren■ Toenableallpeopleandyoungpeopleinparticulartodeveloptheskillsand

attitudesthatwillgivethemthecapacitytoreachtheirfullpotentialandmakehealthychoices.

Thestrategyrecognisesthat■ responsibilitiesforachievingthesegoalsrestswitharangeofdifferent

governmentdepartments■ Actionsneedtobecarriedinpartnershipsbetweenalltherelevantbodies

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■ Thatcommunitiesneedtobeengagedthroughacommunitydevelopmentapproach

AHealthierFutureIn2005theDHSSPSpublisheda20yearvisionforhealthandwellbeinginNorthernIreland2005–2015entitled,AHealthierFuture,to“improvethephysicalandmentalhealthandsocialwellbeingofthepeopleofNorthernIreland”.

Thevisionexplicitlyrecognisesthat“themostimportantfactorsindeterminingthehealthandsocialwellbeingofthepopulationaredeterminedbythecircumstancesinwhichweliveandwork,suchas:• disadvantageandsocialexclusion• poverty• unemployment• loweducationalachievement• socialandcommunityenvironment• housingandlivingconditions• workingconditions• thewiderenvironment.

Ithighlightsthatpoorersocio-economicgroupsarelikelytohavehigherincidenceofcancer,diabetesandotherlong-standingillnesses.

TheVisionrecognisesthatthereneedstobe“anewemphasisonreducingsmoking(esp.amongstchildren),reducingalcohol-relatedharm,tacklinglevelsofobesity,increasinglevelsofphysicalactivityandpromotinggoodmentalhealth.

Itsetsanoutcometo“reducebytwothirdsthegapinlifeexpectancybetweenthoselivinginthemostdeprived20%ofelectoralwardsandtheaveragelifeexpectancyhereforbothmenandwomenbetween2000and2015.

MarmotReviewInNovember2008,ProfessorSirMichaelMarmotwasaskedbythethenSecretaryofStateforHealthtochairanindependentreviewtoproposethemosteffectiveevidence-basedstrategiesforreducinghealthinequalitiesinEnglandfrom2010.Thefinalreport,‘FairSocietyHealthyLives’,waspublishedinFebruary2010,andconcludedthat

■ Reducinghealthinequalitiesisamatteroffairnessandsocialjustice.Themanypeoplewhoarecurrentlydyingprematurelyeachyearasaresultofhealthinequalitieswouldotherwisehaveenjoyed,intotal,between1.3and2.5millionextrayearsoflife.

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■ Thereisasocialgradientinhealth–theloweraperson’ssocialposition,theworsehisorherhealth.Actionshouldfocusonreducingthegradientinhealth.

■ Healthinequalitiesresultfromsocialinequalities.Actiononhealthinequalitiesrequiresactionacrossallthesocialdeterminantsofhealth.

■ Focusingsolelyonthemostdisadvantagedwillnotreducehealthinequalitiessufficiently.

■ Toreducethesteepnessofthesocialgradientinhealth,actionsmustbeuniversal,butwithascaleandintensitythatisproportionatetothelevelofdisadvantage.(proportionateuniversalism).

■ Actiontakentoreducehealthinequalitieswillbenefitsocietyinmanyways.Itwillhaveeconomicbenefitsinreducinglossesfromillnessassociatedwithhealthinequalities.Thesecurrentlyaccountforproductivitylosses,reducedtaxrevenue,higherwelfarepaymentsandincreasedtreatmentcosts.

■ Economicgrowthisnotthemostimportantmeasureofourcountry’ssuccess.Thefairdistributionofhealth,well-beingandsustainabilityareimportantsocialgoals.Tacklingsocialinequalitiesinhealthandtacklingclimatechangemustgotogether.

Thereportrecommendsthatreducinghealthinequalitieswillrequireactiononsixpolicyobjectives:■ Giveeverychildthebeststartinlife■ Enableallchildren,youngpeopleandadultstomaximisetheircapabilitiesand

havecontrolovertheirlives■ Createfairemploymentandgoodworkforall■ Ensurehealthystandardoflivingforall■ Createanddevelophealthyandsustainableplacesandcommunities■ Strengthentheroleandimpactofill-healthprevention.

Itarguesthat:deliveringthesepolicyobjectiveswillrequireactionbycentralandlocalgovernment,theNHS,thethirdandprivatesectorsandcommunitygroups;nationalpolicieswillnotworkwithouteffectivelocaldeliverysystemsfocusedonhealthequityinallpolicies;andeffectivelocaldeliveryrequireseffectiveparticipatorydecision-makingatlocallevel,byempoweringindividualsandlocalcommunities.

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PHACorporateStrategyThisreporthashadasignificantimpactonthecorporatestrategyofthePublicHealthAgency(PHA)inNorthernIreland,Realising the health and wellbeing potential of people,whichhasfourprioritiesforimprovinghealthandwellbeing:

■ Giveeverychildthebeststartinlife■ Workwithotherstoensureadecentstandardofliving■ BuildsustainableCommunities■ Makehealthierchoiceseasier

Actionstopromotetheseprioritiesinclude■ CommissioningFamilyNursePartnershipsandotherevidence-basedfamily

supportforfamilieswhodonotqualifyforFNP■ Reviewingantenataleducationtopromoteparentchildinteractionandinfant

brainandemotionaldevelopment■ Breastfeedingpeersupportprogrammes■ RootsofEmpathyprogrammesinschools■ Supportingsocialeconomybusinessesandcommunityskillsdevelopment■ Supportincrementalexpansionofprogrammestodevelopthetop20%most

disadvantagedcommunities■ ImplementtheFitterFuturesforAllframeworktoaddressobesity■ StopSmokingSupportservicesespeciallyforpregnantwomen■ Putinplaceintegratedplanstopreventsuicideandpromoteemotionalhealth

PHACommunityDevelopmentThematicActionPlanThePublicHealthAgencyrecognizesthecrucialimportanceofusinganasset-basedcommunitydevelopmentapproach,whichlooksbeyondthemedicalmodelinimprovinghealthandwellbeingandclosinghealthinequalities.Therearefourmainstreams:

■ Directcommunitydevelopmentsupporttoorganizationsandcommunities■ Commisioningofserviceswhichpromotesustainablecommunities■ Commissioningofhealthandwellbeingimprovementservicesfrom

community-basedorganisations■ Innovationandtestingoutnewwaysofworking.

MentalHealthReviewIn2006acomprehensiveReviewofMentalHealthandLearningDisabilitywascarriedoutbyBamfordmakingawideRangeofrecommendationsforhowservicesinthisareacouldbeimproved.In2009theNIExecutivepublisheda2009-2011ActionPlaninresponsetotheReview,includinganaimtopromote“positivehealth,well-beingandearlyintervention”.Theseplannedactionsincluded:

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■ Publisharevisedcross-sectoralPromotingMentalHealthandWellbeingStrategy

■ Develop,consultonandimplementanEarlyYearsStrategy■ Introducearevisedcurriculumwhichprovidesopportunitiesthroughpersonal

developmentandotherareasforyoungpeopletodeveloptheskillstheyneedtocopewithchallengingpersonalsituationssuchasviolenceagainstwomenandchildren;self-harmetc.

■ Sustainindependentcounselingsupportserviceinpost-primaryschools■ Produceguidanceforpost-primaryschoolsonproactivelypromotingpositive

emotionalhealthandwellbeingamongstaffandpupils

SexualHealthPromotionInNovember2008DHSSPSpublishedaSexualHealthPromotionStrategyandActionPlan,inordertoimprove,protectandpromotethesexualhealthandwellbeingofthepopulationinNorthernIreland”.Itsobjectivesinclude:■ Toreducethenumberofunplannedbirthstoteenagemothers■ Topromoteopportunitiestoenableyoungpeopletomakeinformedchoices

beforeengaginginsexualactivity,especially,empoweringthemtodelayfirstintercourseuntilanappropriatetimeoftheirchoosing.

Theapproachofthestrategyincludesensuringthatservicesareaccessibleandresponsivetoneed,includetheneedsofdisadvantagedgroupsandthoseathighestrisk;andactiontotacklethedeterminantsofsexualhealthbasedonanevidencedbasedapproach.

TheStrategyacknowledgesthatthereisa“stronglinkbetweensocialdeprivationandSTIs,abortionsandteenagepregnancyandearlymotherhoodisassociatedwithpooreducationalachievement,poorphysicalandmentalhealth,socialisolationandpoverty”.ResearchinNorthernIrelandhasshownthat“respondentsfromapartlyskilledsocio-economicbackgroundweretwiceaslikelyasthosefromaprofessional/managerialbackgroundtohavehadsexualintercoursebeforetheageofsixteen”.

AcrucialaspectoftheSexualHealthPromotionStrategyisPrevention,including“everyonehavingthelifeskillsandaccesstoservicestoenablethemtomakeinformedchoicesandtodeterthedevelopmentofhealthcompromisingbehaviours.Thisisparticularlyimportantforyoungpeopleasthemajorityofparents,healthandeducationalprofessionalsagreethatsexualrelationsarebestdelayeduntilayoungpersonissufficientlymaturetoparticipateinamutuallyrespectfulrelationship”.

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Italsostressestheimportanceofparentsandcarershavingthe“skillsandknowledgetotalktotheirchildren,asgoodparent/childcommunicationandsexualhealthissuescanhelpdelayfirstsexualexperienceandlimitpoorsexualhealthoutcomes”IthighlightsthepotentialroleofSureStart,HealthySchools,HealthActionZonesandHealthyLivingCentresinpromotingpartnerships.

Thestrategyalsoacknowledgesthat“schoolshaveanimportantcontributiontomakeininfluencinganddevelopingyoungpeople’ssexualhealthandwellbeingthroughthedeliveryofeffectivePersonaldevelopment,includingRelationshipandSexualEducation”.

Thestrategysetsspecifictargetsincludingthefollowing:■ 92%of11-16yearoldsshouldnothaveexperiencedsexualintercourseby

2013■ Areductionof25%intherateofbirthstoteenagemothersunder17yearsof

ageby2013.

SpecificactivitiesintheActionPlanincludethefollowing:■ TocontinuetoimplementguidelinesonRelationshipsandSexualEducation■ Toprovideopportunitiestoyoungpeopleinschoolandyouthsettings

todeveloptheskillstheyneedforlifetosupporttheminappropriatelymanagingtheirrelationships,includingsexuallifestyles

■ Tofurtherdevelop,particularlyinareasofsocio-economicdeprivationandruralareas,communitybasedteenagepersonaldevelopmentprogrammesthatwillincorporatesexualhealthissuesandrisktalkingbehaviour

SuicidePreventionIn2006theDHSSPSissuedits5-yearSuicidePreventionStrategyandActionPlan,Protect Life,followingverysignificantconcernaboutthenumberofsuicidesinNorthernIreland,particularlyamongstyoungpeople.Actionstobedeliveredbyvariouspartnersincludedwere:■ Toprovidefamilieswiththeopportunitytoavailofnon-stigmatising

practicalinterventionstohelpconsolidateparenting,copingandlifeskills■ Topromotetheinclusionofpromotingpositivementalhealthasakey

elementofthe“HealthyScvhools”programmeandensurethatchildrenandyoungpeopleareprotectedfromallformsofbullying

■ Toraiseawarenessofandensureavailabilityandtimelyaccesstoappropriateinterventionservices(e.g.ChildandAdolscentMentalHealthServices,mentoringschemesandotherappropriatestatutoryandvoluntaryservices).

■ Encouragetheinclusionofcopingandlifeskills,emotionalliteracy,andprogrammesthatpromotepositivementalhealthintheschoolcurriculum

■ TodevelopenhancedlinkagesbetweentheHealthandSocalServicesandthe

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community/voluntarycounselingandsupportnetwork,particularlyinrelationtotransitionservicesandtobridgeanygapsinserviceprovision

■ Toenhancetheroleofthecommunity/voluntarysectorconcerningtheprovisionofmentoringsupportforyoungpeopleatriskofsuicideandself-harm

■ Toensurethatappropriatesupportservicesreachouttoallmarginalizedanddisadvantagedgroups,inparticularlesbian,gay,bi-sexual,andtrans-gendergroups,ruralcommunities,ethnicminorities,andthosepeoplewhoareeconomicallydeprived.

AlcoholandDrugsIn2006theDHSSPSpublisheda5-yearcross-sectoralstrategy,New Strategic Direction for Alcohol and Drugs,thatsoughttoreducetheharmrelatedtobothalcoholanddrugmisuseinNorthernIreland(seeoutlineofdraftPhase2below).

In2008theDHSSSPSpublishedaRegional Hidden Harm Action PlantorespondtotheneedsofchildrenborntoandlivingwithparentalalcoholanddrugmisuseinNorthernIreland.ThePlanhighlightssomeofthepotentialimpactsforachildoflivingwithparentalalcoholordrugabuse,including:■ Harmfulphysicaleffectsonunbornandnewbornbabies■ Impairedpatternsofparentalcareandroutineswhichmayleadtoearly

behaviouralandemotionalproblemsinchildren■ Higherriskofemotionalandphysicalneglectorabuse■ Lackofadequatesupervision■ Povertyandmaterialdeprivation■ Repeatedseparationfromparents…■ Childrentakingoninappropriatesubstitutecaringrolesandresponsibilities

forsiblingsandparents■ Socialisolation■ Disruptiontoschoolingandschoollife■ Earlyexposuretoalcoholanddrugmisusingcultureandassociatedillegal

activitiesandlifestyles■ Poorphysicalandmentalhealthinadulthood

Theprinciplesunderpinningtheactionplaninclude“Afocusonpreventionandearlyidentification”andthatservicesneedtobebasedon“evaluationofeffectiveness”,aswellaswhatchildrenandparents/carerssaytheyneed.

TheActionPlanoutlineswhatshouldbeincludedinacontinuumofspecialistservices,including:■ Familyplanningservices■ Maternityservices

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■ Post-natalandearlyYears■ Specialistservicesandsupportforchildren(andprovidessomeUKexamples)■ Confidentialhelpandadvice■ Parentinginterventions,including“well-evaluatedparentingprogrammes,

suchasWebster-Stratton,andspecificprogrammestargetedtosubstancemisusingparents(andgives3UKexamplesofservices)

■ Familyfocusedservices,includingfamilytherapies,parentingwork,1:1workincludingcounselingwithchildrenandwithparents

■ practicalsupport■ Art,dramaandplaytherapy

In2009theDepartmentissuedanActionPlan,Addressing Young People’s Drinking in Northern Ireland,tosupporttheNew Direction for Alcohol and Drugs.ThePlanaimstoreduceboththesupplyof,anddemandfor,alcoholamongstyoungpeople;preventandreducetheharmsfromalcoholuse;andidentifyandprovidetheappropriatesupportforthosemostvulnerableoratrisk.TheprincipleswhichunderpinthePlanincludetheroleoffamilies,theneedforevidence-basedinformation,theidentificationoflocalneeds,andafocusonthemostdisadvantagedareasthroughtheNeighbourhoodRenewalAreas.Actionsinclude:■ Delivery,inaconsistentmanner,alcoholeducationtoallyoungpeoplein

schools;develop,and/orenhancelocalpeerlearning/informationprojectsandinitiatives

■ Localcommunitiestoidentifyanddevelopsupport/diversionaryactivitieswhereyoungpeople’sdrinkingisidentifiedasanissue

■ Continuetoprovideinformation,interventionsandprogrammesonsafesexualpractices,promotingmentalhealth,suicideandself-harm,homeaccidents,trafficaccidents–particularlytargetingyoungdrinkersandthoseyoungpeoplelivinginNeighbourhoodRenewalAreas

■ Developaresearchprogrammeonyoungpeopleandalcohol,andensureallinitiativesarerobustlyevaluated

■ Commissionandpublisharangeofresearchandevaluationstouncoverwhichinterventionsmosteffectivelyaddressthisissue…

■ LocalHiddenHarmActionplansdevelopedandeffectivelyimplemented andthattakefullaccountofissuesrelatingtoalcoholmisuse…fromconception

to18

InJanuary2011theDepartmentissuedaconsultationdocumenttoreviseandextendtheoriginalstrategy(New Strategic Direction for Alcohol and Drugs Phase 2 2011-2016)ratherthanproduceanewstrategy.Objectivesintherevisedstrategyincludeto“promoteopportunitiesforthoseundertheageof18yearstodevelopappropriateskills,attitudesandbehaviourstoenablethemtoresistsocietalpressurestodrinkalcoholand/ormisusedrugs.

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SomeoftheemergingissueshighlightedbytheDraftNewStrategicDirectioninclude:■ Familiesandhiddenharm■ Mentalhealth,suicideanddrugsandalcoholmisuse■ Alcohol■ Linkswithsexualviolenceandabuse,anddomesticviolence.

Theprinciplessetoutintakingthestrategyforwardinclude:■ Evaluation,EvidenceandGoodPracticeBasede.g.informedbyevidenceof

theproblemsand“whatworks”andimprovingtheevidencebasethroughevaluation

■ Partnershipandworkingtogether■ Addressinglocalneed■ CommunityBased■ Long-termfocus

ThedraftNew Strategic DirectionhighlightsPreventionandEarlyInterventionasoneofthecriticalsupportpillars.Itstatesthat“PreventionandearlyInterventionislargelyconcernedwithencouraginganddevelopingwaystosupportandempowerindividuals,familiesandcommunitiesintheacquisitionofknowledge,attitudesandskills”.Itrecommendsthat“aparticularfocusshouldbeputontheimportanceofearlyintervention(especiallyyoungchildrenandfamilies)andtheadoptionoftargeted,aswellasuniversaltypesofpreventionwhichwillleadtothereductionofriskfactorsandthedevelopmentofprotectivefactorsassociatedwiththepreventionofalcoholanddrug-relatedharm”.Italsoarguesthat“interventionsmustbetailoredtoparticularsettingssuchastheschool,communityandworkplace…Theimportanceofformalandinformaleducationandcommunity-basedapproachesisacknowledged.”

ItrecommendsthatresourcestodelivertheNew Strategic Directionshouldbe“properlytargetedatactivitiesandprogrammesthathavebeenshownbypreviousresearchandevaluationtobeeffective”.

ThesuggestedKeyPrioritiesinclude:■ Targetingthoseatriskandvulnerable,includingvulnerableyoungpeople(e.g.

childrenandalcohol/drugusingparents;andschoolexcludees)■ Promotinggoodpracticeinrespectofalcoholanddrug-relatededucation

andprevention,basedon“soundconceptualprinciplesand…evidencedgoodpractice”

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TheDraftStrategyoutlinesshorttolongtemoutcomes,includingreducingtheproportionofyoungpeoplewhodrinkonaregularbasis;whogetdrunk;whotakedrugs.

MaternityStrategyIn2011DHSSPSissuedadraftMaternityStrategyforconsultation,whichrecognisesthat“disadvantagestartsbeforebirthandaccumulatesthroughoutlife”.Ithighlightsthefactthatthoseindeprivedcommunities,youngermothers,motherswhodonotbreastfeed,motherswhosmoke,drinkheavily,usedrugs,orareobesearemorelikelytohavepoorerpregnancyoutcomes.Itacknowledgesthatifhealthinequalitiescanbereducedbefore,duringandafterpregnancythiswillimpactonthefuturehealthofthepopulation.

TacklingHealthinequalityatasub-regionallevelTheSouthEasternHealth&SocialCareTrust(SEHSCT)hasitsownHealthInequalityActionPlan2011/12,whichfocusesonthemostdeprived20%ofareaswithintheTrust(whichincludesOldWarrenandTonagh)includingthefollowingobjectives:■ SupporttheEmotionalDevelopmentofyoungchildreninthe20%most

deprived(NeighbourhoodRenewal/SureStart)areas–• throughthedeliveryofRootsofEmpathyprogramme“withastrong

evidenceforeffectiveness”• Supportingparentsindevelopingtheirchildren’semotionalfoundations

throughtheNewParentProgramme,IncredibleYearsParentingProgrammeandMellowParents/MellowBabiesprogrammes

■ Reducesmokinginthe20%mostdeprivedareasincludingananti-natalincentiveandsupportscheme

■ Reducechildhoodobesityinthe20%mostdeprivedareas,throughMini-Mendfor2-4yearoldsinSurestart

■ Mentalhealth,Suicidepreventionandselfharmby• Deliveringamentalhealthprogrammeinsecondaryschoolsinthe20%

mostdeprivedareas• Acommunicationandtrainingprogrammeinthe20%mostdeprived

communities■ Drugsandalcoholbydevelopinganddeliveringanewprogrammeaimedatthe

familiesofteenagedrinkers■ Supportsocialenterprise/employmentschemesinneighbourhoodrenewal

arease.g.Kilkooley,ColinBridgeandBallymote■ Improveoutcomesforlookedafterchildren

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4.3Children,YoungPeople&Families

TheGovernment’s10-yearStrategyforChildrenandYoungPeopleIn2006,OFMDFMpublisheditsinter-departmental10-yearstrategyforchildrenandyoungpeople-Our Children and Young People – Our Pledge(OFMDFM2006)settingout6highleveloutcomesforchildrenandyoungpeoplethatallagenciesinNorthernIrelandshouldbeworkingtowards:Childrenandyoungpeopleshouldbe:

■ Healthy■ Enjoying,learningandachieving■ Livinginsafetyandwithstability■ Experiencingeconomicandenvironmentalwellbeing■ Contributingpositivelytocommunityandsociety■ Livinginasocietywhichrespectstheirrights

Thesupportingthemesofthe10yearstrategyincludethefollowing:■ Theneedtoadopta“whole-child”approach,whichgivesrecognitiontothe

complexnatureofourchildren’sandyoungpeople’slives■ Workinginpartnershipwiththosewhoprovideandcommissionchildren’s

services…■ Securingandharnessingthesupportofparents,carersandthecommunities

inwhichourchildrenandyoungpeoplelive■ Makingagradualshifttopreventativeandearlyinterventionapproaches

withoutcompromisingthosechildrenandyoungpeoplewhocurrentlyneedourservicesmost

TheStrategycontainsaspecificpledge“wewillpromoteamovetopreventativeandearlyinterventionpracticewithouttakingattentionawayfromourchildrenandyoungpeoplecurrentlymostinneedofmoretargetedservices.

Italsocontainsapledgeto“deliverimprovedoutcomesforallchildrenandyoungpeople,wewillensurethatallfuturepoliciesdevelopedandservicesofferedto,andaccessedby,childrenandyoungpeople,arebasedonidentifiedneedandonevidenceaboutwhatworks”.

Implementationandresourcingofthe10-yearstrategyhasbeendisappointingtomanyoftheorganisationsconcernedwithchildoutcomes.TheOFMdFMChildren’sUnithasbeenincorporatedintoawiderdepartment.

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ChildrenandYoungPeople’sStrategicPartnershipIn2011aChildrenandYoungPeople’sStrategicPartnership(CYPSP)wasestablishedtoimproveoutcomesforchildrenandyoungpeoplethroughintegratedplanning.

TheCYPSPisthefirstChiefExecutiveledcrossagency,crosssectoralintegratedplanningandcommissioningprocessforNorthernIreland.ThisincludesALLstatutorysectororganisationswithresponsibilityforchildrenandyoungpeopleandrepresentativesfromVoluntaryandCommunityandBMEsectors.WithafocusonearlyinterventiontheChildrenandYoungPeople’sPlanisthekeydriverforthiswork.

ThePartnershiphasdevelopeda“NorthernIrelandChildrenandYoungPeople’sPlan2011-2014,whichsetsouthowintegratedplanningandcommissioningarrangementswillbeputinplacetosecureimprovementsinthe6highleveloutcomesforchildrenandyoungpeople(highlightedabove).OneofthefourthemesofthestrategyisEarlyIntervention–inparticular,seekingdesignationofNorthernIrelandasasiteforearlyinterventionandsupportingallagenciestoworktogetherinrelationtotheintegratedplanningandcommissioningofearlyintervention.Theotherthemesare“CommunicatingwithGovernment”,“IntegrationofPlanning”and“OptimisationofResources”.

ApartfromthedefinitionofearlyinterventionandhowtheCYPSPhasagreedtotakeforwardearlyintervention.OneoftheactionswithintheChildrenandYoungPeople’sPlanincludesthedevelopmentofastandardisedresilienceframeworkfortheevaluationofearlyinterventionprogrammesacrossNorthernIreland.

Outcomegroupshavebeenestablishedineachsub-region.TheSouthEasternOutcomesGroup,whichawidemembershipfromthestatutory,voluntaryandcommunitysectors,hasbeenmandatedbythePartnershiptoimplementoutcomesbasedplanningforLisburn&DownandNorthDown&Ards.ThepurposeoftheSouthEasternOutcomesGroupisto“carryoutintegratedplanningandcommissioningforchildrenandyoungpeopleinthearea,withspecificemphasisonsharingresourcesacrossagenciestoimproveoutcomesforchildrenandyoungpeople”.TheOutcomesGroupiscurrentlylookingattheestablishmentordesignationofmorelocalLocalityGroups(suchasColinEarlyInterventionCommunityandEarlyInterventionLisburn)tocarryoutoutcomesbasedplanningatthelevelofgeographywhichmakessenselocally.

TheSouthEasternOutcomesGrouphasalsosetinplacethefoundationsforageographicallybasedFamilySupportHubtoengagewithfamilieswhodonotmeetthethresholdforstatutorysocialworksupportandimproveco-ordinationof

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servicedeliverytoindividualfamilies.Barnardo’shasbeencontractedtodeliverthefamilysupportservicethroughthreefamilysupportworkersinLisburn.Itiscurrentlydealingwithc.50referralspermonth.

DHPSSPSFamiliesMatter(2009)TheDHSSPSFamilysupportstrategy,Families Matterisbasedonthesixoutcomesinthe10yearstrategyforchildrenandyoungpeopleandafamilysupport(Hardiker)modelwithfourlevels:

Level1:AllchildrenLevel2:ChildrenwhoarevulnerableLevel3:ChildreninneedinthecommunityLevel4:Childreninneedofrehabilitation

Thestrategyacknowledgesthat“earlyinterventionproducespositivedividendsintermsofchildrenandfamiliesnotneedingmorespecialistservicesatalaterdate”andthe“currentinequityinresourcingearlyinterventionservicescomparedtothoseofhigherneedsandthismustbeaddressed”.

ThestrategyhighlightsfourprioritythemesforDHSSPS:■ Informationforparentsandserviceplanners■ Access,includingavoidingstigma,language,etc■ SupportingFamiliesandParents,includingParentingEducation,Positive

Parenting,localitybasedservicese.g.extendedschools,children’scentres,relationshipsupport/mediationandSurestart

■ WorkingTogetherforfamiliesandCommunities,includingmulti-agencyworkingandcommonassessment

HealthChild,HealthyFutureTheDHSSPSpublishedaFrameworkfortheUniversalChildHealthPromotionProgrammeinNorthernIrelandfrompregnancyto19years,in2010.Itisbasedontheconceptofprogressiveuniversalismi.e.everychild/familyreceivesastandarduniversalservicei.e.setcontactsbythemidwife,healthvisitorandschoolnurse,etc.tothestandardsintheframework.However,acomprehensiveassessmentofneed(UNOCINI)shouldidentifywhereadditionalearlyinterventionsupportandinterventionsaretobeofferedtoamelioratethepotentialearlynegativeimpactofanyphysical,socialoremotionalfactor,suchasSurestart,breastfeedingsupport,counseling,evidence-basedparenting,thusreducinginequalities.Wherethisearlyinterventionisunabletoaddresstheneed,children/familiesareescalatedtoamoreprogressivelevelofinterventiontosafeguardthewelfareofthechild.

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Thestrategyrecognisestheparticularimportanceofprovidingadditionalsupporttopregnantteenagersduetothehigherriskoflowbreastfeeding,lowbirthweight,highinfantmortality,highchildaccidents,highpostnataldepression.

TheFrameworkrecognisesthedevelopedunderstandingoftheneurologicaldevelopmentofachild’sbrain,theimportanceofparent-childattachmentinthefirstfewyearsoflife,andthenegativeimpactofmaternalstressinpregnancy.AmajoremphasisintheFrameworkisontheprovisionofparentingsupportandpositiveparentinge.g.usingagreedevidence-basedprogrammestosupportspecificworke.g.Solihullapproach,IncredibleYears,MellowParenting,theSocialBabyBook/Video,andBabyExpressNewsletters.

TheFrameworkaimstoachieve10specificoutcomes:■ Strongparent-childattachmentandpositiveparenting,leadingtobettersocial

andemotionalwellbeingamongchildren■ Carethathelpskeepchildrenhealthyandsafe■ Healthyeatingandincreasedactivity■ Preventionandreductionofsomeseriousdiseasesandcommunicablediseases■ Increasedratesofinitiationandcontinuationofbreastfeeding■ Readinessforschoolandimprovedlearning■ Earlyrecognitionofgrowthdisordersandriskfactorsforobesity■ Earlydetectionandactions(includingearlyintervention/referral)toaddress

developmentaldelayandillhealthandconcernsaboutsafety■ Identificationoffactorsthatcouldinfluencehealthandwellbeinginfamilies■ Bettershortandlongtermoutcomesforchildrenwhoareatriskofsocial

exclusion

TheFrameworkincludesthefollowingcoreelements:

■ Healthimprovement• Supportforparenting:EarlyInterventionandpreventionprogrammesfor

childrenandfamilies• Engagingfathers/partners• Healthpromotionincluding“stronglinksandclosercommunication

withcommunitydevelopmentprogrammesandotherinitiativesaimedatreducinginequalities,socialexclusion,eliminatingpovertyandimprovingeducationaloutcomes”

• PromotionofSocialandEmotionalDevelopment• Safeguarding

1 Theevidencebaseforsomeoftheseinterventionsisweakerthanothers

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• Schoolhealthprofiling,inorderto“developpreventionandearlyinterventionprogrammestoaddresstheneedsofthispopulationwiththeschoolsettingandwithinlocalcommunities”(Note:PHAtoleadtodeveloponetoolsupportedbyICT)

■ Healthprotection• Surveillance• Screening• Immunisation

DiscussionswithcommunitygroupsandthoseinvolvedinhealthvisitinghashighlightedthelackofresourcesavailableinNorthernIrelandtoeffectivelydeliverytheHealthy Child, Healthy Futureframework.Although,perhapsbetterintheSETrustareathanotherTrustareas,ahealthvisitorintheSETrustareaislikelytohaveacaseloadof300-400+families.Tobeabletoprovidemoreintensivesupportforthemostvulnerablenewmothers(fromthe20thweekofthepregnancytotwoyearsold)theTrusthasintroducedtheevidence-informedNew Parenting Programme.AnadditionalhealthvisitorisemployedinbothOldWarrenandHilhall,withacaseloadof25familieseach.ThedeliveryoftheserviceisbeingevaluatedbyQUB(notwithacontrolgroup).AsimilarmodelisbeingdeliveredintheColinarea,withahealthvisitorplustwosupportworkers.Theevidence-informed(butnotaprovenprogramme)10-14weekparentingskillsprogramme,Mellow Parents,developedinScotland,isalsobeingdeliveredinOldWarrenbytheTrust.

ChildPovertyStrategyTheChildPovertyAct2010placesastatutoryobligationontheNIExecutivetodevelopachildpovertystrategy.TheExecutive’sstrategyisdesignedtotryandbreakthecycleofpovertyandunderachievementby“raisingaspirations,increasingaccesstoopportunitiesthrougheducation,supportingparentsintowork,and,providingthenecessarysupporttothosemostinneedsuchaschildrenwithdisabilities,loneparentsandothers”.

Thecross-departmentalStrategysetsoutthekeyareasthattheExecutivebelievesarecrucialinaddressingthecausesandconsequencesofchildpovertyandinmeetingtheGovernment’sobligationsinTheAct.TheStrategyhastwokeystrandsofworkrelevanttothecausesandtheconsequencesofchildpoverty:

1. reducingworklessnessamongstadultswithchildren2. promotelongertermoutcomesthroughchildbasedinterventionswhichare

designedtotacklethecyclicalnatureofchildpoverty

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TheStrategyhighlightsanumberofprinciplesthatunderpinandshouldsupportthedeliveryofthestrategy:■ Ashifttowardstacklingtherootcausesofpovertyandnotjusttreatingits

symptoms.■ PuttingchildrenatthecentreoftheStrategyandtakingintoaccounttheir

viewswhendevelopingpoliciesandprogrammestotacklechildpoverty.■ AdoptingaLifeCycleapproach,breakingthecyclethatresultsinchildren

bornintopovertybecomingworkingageadultsinlowincome.■ Promotingexcellenceinsupportacrossarangeofkeypolicyareasincluding

employmentandskills,education,childcare,healthandfamilysupport,housingandneighbourhoods,andfinancialsupport.

■ Agradualshifttowardstheuseofpreventativemeasurestotacklechildpovertyand,whenfamiliesfacedifficulties,interventionatanearlystage,reducingthelikelihoodofmoreseriousproblemsdevelopinginthefuture

■ Applyinganevidencebasedapproach.■ Adoptingawholefamilyapproachwhichconcentratesonallmembersofthe

family-children,youngpeople,andtheirparentsandsupportingfamilylife.■ Empoweringandenablingparentsonlowincomeintoworkandmakework

payforthoseonlowpay.■ Promotingpartnershipworkingacrossallsectorsincludingpublic,private,

voluntary,andcommunitysectors.■ RecognisingthecurrenteconomicclimateandtheneedfortheStrategytobe

balancedagainstexistingfinanciallimits.

TheKeyStrategicPrioritiesintheStrategyareasfollows:■ Ensure,asfaraspossible,thatpovertyanddisadvantageinchildhooddoesnot

translateintopooreroutcomesforchildrenastheymoveintoadulthood.■ Supportmoreparentstobeinworkthatpays.■ Ensurethechild’senvironmentsupportsthemtothrive.■ Targetfinancialsupporttoberesponsivetofamilysituations.

SomeoftherelevantActionAreasundertwoofthesepriorities,whicharerelevanttoanearlyinterventionapproachareasfollows:

Ensure,asfaraspossible,thatpovertyinchildhooddoesnottranslateintopooroutcomesforchildrenastheymoveintoadultlife■ Provideallchildrenandyoungpeoplewithopportunitiestoreachtheir

educationalattainmentregardlessofbackgroundandaddressbarrierstopupilsachievingtheirfullpotential.

■ Supportdisadvantagedfamiliestopromotethephysical,social,intellectualandemotionaldevelopmentoftheirchildrensothattheyflourishathomeandwhentheygettoschool.

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■ Supportthedeliveryofanaccessible,flexibleandqualitychildcaresector,sothatitiseffectiveinreducingbarrierstoemployment,particularlythoseexperiencedbydisadvantagedgroups,andsupportschilddevelopmentandwellbeing”.

■ Improvehealthoutcomesandtargetthosegroupswhoareparticularlyatriskorvulnerable,inordertotacklehealthinequalitiesofchildrenandyoungpeople.

■ Strengthenandimprovepreventionandearlyinterventionforallchildrenandtheirfamilies,particularlyinthefirstthreeyearsoflifetomaximisefutureoutcomesinhealthandwellbeing.

■ Providefamilysupportandinterventionservicestochildreninvulnerablefamilies.

■ Improveschoolreadinessandincreaseparticipationinformalandnon-formaleducation,youthservicesandsportsthroughaccessibleandaffordableculture,artsandleisureservices.

■ Addresssocio-economicdisadvantageinchildrenandmaximiseaccesstokeyservicesforchildrenandyoungpeople.

Ensurethechild’senvironmentsupportsthemtothrive:■ Promoteaffordable,accessibleplayandleisureprovisionforallchildrenand

youngpeople.■ Providedifferentlearningenvironmentsthroughyouthserviceswhich

complementformallearningandarefocusedonthepersonalandsocialdevelopmentofchildrenandyoungpeople.

■ Toimproveopportunitiesforlowincomefamiliestoparticipateinarts,cultural,sportingandleisureactivities.

■ Ensurethatparentscanaccessinformationandservices,includingtheRegionalFamilySupportDatabaseintheirlocalareastosupportthemincarryingouttheirparentalresponsibilities.

■ Makepublictransportmoreaccessibleandaffordabletoallchildrenincludingthosewithadisabilityinbothurbanandruralareas.

■ Continuetotakeactiontoaddressfuelpovertyinvulnerablehouseholds.■ Ensurechildrenandyoungpeoplearelivinginhomeswhichachievethe

DecentHomesStandard.■ Supportstatutoryandvoluntaryagencies,includinglocalcouncils,to

provideservicesandprogrammeswhichmeettheneedsoflocalcommunities,particularlydisadvantagedcommunities.

■ Continuetoaddresstheunderlyingcausesofdisadvantageandimprovethephysicalenvironmentofthemostdeprivedneighbourhoods.

AnactionplantoimplementtheChildPovertystrategyisexpectedtobepublishedbytheSummer2012.

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4.4Education

Everyschoolagoodschool–apolicyforschoolimprovementTheDepartmentofEducationundertookareviewofthepreviousschoolimprovementpolicyandissuedthefindingsofthisreviewandproposalsforthewayforwardforpublicconsultationinJanuary2008.Followingconsultation,thefinalisedpolicydocument,EverySchoolAGoodSchool-APolicyforSchoolImprovementwaslaunchedbythethenEducationMinister,CaitrionaRuaneinApril2009.

TheDepartment’svisionis“toensurethateverylearnerfulfillshisorherpotentialateachstageofherorhisdevelopment”.

Thepolicyrecognisesthat“therearestilltoomanyyoungpeoplefinishingtheir12yearsofcompulsoryschoolingwithoutreaching”5+GCSEsgradeA*-C,especiallythosewhoareeconomicallyandsociallydisadvantaged,sothat“schoolsservingdisadvantagedcommunities,andcommunitieswherethevalueplacedoneducationmaynotbeashighasitmightbe,willneedmuchgreaterlevelsofsupport”.Inspectorshavereportedthatinone-thirdofprimaryschoolsinspectedthequalityofprovisionwasnotgoodenough(ChiefInspector’sReport2006-2008).

Thepolicyhighlightsthecharacteristicsandindicatorsofagoodschoolwitheffectiveperformance,inrelationto:■ Child-Centredprovision■ Highqualityteachingandlearning■ Effectiveleadership■ Aschoolconnectedtothelocalcommunity

TheDepartmentcommits,amongstarangeofthings,to“maintainingaparticularfocusontacklingthebarrierstolearningthatmanyyoungpeopleface”andinparticularto“continuetosupportworkthroughthedevelopingpupil’semotionalhealthandwellbeingprogrammeandthecounsellingprovisioninschoolsinordertobuildpupil’sresiliencetodealwithchallengesintheirlivesandimprovetheirreadinesstolearn”;andtoplanandtrackliteracyandnumeracybetterthroughcleareroutcomes.

ThePolicyalsorecognisestheimportanceof“increasingengagementbetweenschoolandparents,familiesandcommunitiestheyserve”,through■ TheExtendedSchoolsProgrammewhichsupportsover400schoolsin

disadvantagedcommunities,will“continuetoensurethatthoseschoolsservingthemostdisadvantagedcommunitiesreceiveadditionalsupportto

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provideactivitiesoutsideofnormalschoolhoursthatreflectandrespondtotheneedsoftheirpupilsandthelocalcommunity”

■ Fullserviceextendedschools(alreadybeingpilotedin3Belfastschool)–theDepartmentwill“publishastrategyforthefurtherdevelopmentofthisconcept”

■ Healthpromotingschools(200schoolsalreadyengaged)■ Identifyinganddisseminating“goodpracticewithaparticularfocuson

communityuseofschoolstohelpschoolsinbuildingstrongerlinkswiththeirparentsandlocalcommunities”

ExtendedSchoolsTheExtendedSchoolsconceptwasoriginallyintroducedinNorthernIrelandin2006,basedonExtended Schools: schools, families, communities – working togetherdocumentpublishedbytheDepartmentofEducation.ExtendedSchoolsweretobeschoolswhich:

■ viewsworkingwithitspupils,familiesandcommunityasanessentialelementinraisingthestandardofpupilsachievement;

■ buildspartnershipswithneighbouringschools,thefurthereducationsectorandotherstatutory,voluntary,businessandcommunityorganizationstodevelopanddeliverbetterservicesforthecommunityasawholeandforchildrenandyoungpeopleandtheirfamiliesinparticular;

■ helpstostrengthenfamiliesandcommunitiesthroughprovidingopportunitiesforlifelonglearningandpersonaldevelopment;and

■ usesitsaccommodationflexiblyandoutsideofschoolhoursforthegoodoflearnersandthecommunity.

Thedocumenthighlightsalargenumberofpotentialbenefitsforpupils,schools,familiesandcommunitiesfromengagementwithExtendedSchools.

ThecriteriaforreceivingExtendedSchoolsfundingforprimaryandnurseryschoolswasinclusioninaneighbourhoodrenewalarea;beinthe30%lowestrankingwardsorSOAsinrelationtotheEducationdomain;orFreeSchoolmealsentitlementof37%ofhigher.Intermsoffundingschoolsweretoreceiveablockallocation,plusanamountperpupil,basedonaslidingscale,plusanextraallowanceforbeingpartofacluster.SchoolswererequiredtosubmitaproposedExtendedSchoolactionplan.

FollowingETIevaluationsoftheExtendedSchoolsProgrammein2009and2010,whichshowedprogressbutrequiredbetterintegrationwithwhole-schoolimprovementplanningandmoreattentiontoraisingstandardsandtheachievementofspecifichighleveloutcomes,inNovember2010theDepartment

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issuedarevisedCircularonExtended Schools – Building on Good Practice.Itstatesthat“theprimaryfunctionofanExtendedSchoolmustbetoraisestandardsthroughtheprovisionoftargetedsupportserviceswhichhaveafocusonlearning,developmentandprogress”and“topromote,supportandsustainthedrivetomaximizelearningandachievementforthosechildrenandyoungpeoplemostinneedorwhoareatriskofloweducationalattainment”.Itstaesthat“Aboveeverythingelse,itmustberememberedthattheactivitiesandservicesprovidedbyExtendedSchoolsmustbefocusedonthecorepurposeofimprovingchildren’slearningandlevelsofeducationalattainment”.

TheCircularstatesthateffectiveExtendedSchoolsprogrammeshave:■ Mappedprovisioninrelationtodataandanalysisofneed;■ Joinedupplanswithotherprovisionsuchastheyouthservice,health,

neighbourhoodrenewal,andcommunityrelations;■ Activelyparticipatedinaclusterworkingtopromotethesharingofprovision

andexpertisebetweenschoolsandpromotedcrosscommunitycollaborationwherepossible;and

■ Engagedwiththevoluntaryandcommunitysectorinthedeliveryofservicesandactivitiesallowingschoolstobuildtheircapacity.

PuttingPupilsFirst:ShapingOurFutureInhisfirstpublicpolicystatement,inSeptember2011,whichwaspublishedasPuttingPupilsFirst:ShapingOurFuture’JohnO’Dowdsetouthisvisionforeducation.Thisincludedthefollowingstatement:

“Infocusingontheneedsofallchildren,wemuststartbylayingtherightfoundationsforlearninginthoseall-importantearlyyears”

ItalsoincludedacommitmenttofinalisingtheEarlyYearsStrategy.Thedraftstrategysetoutto,amongstotherobjectives,“promotingbetterlearningoutcomesforchildrenbytheendoftheFoundationstage,especiallyinlanguageandnumber;andinthechildren’spersonalandsocialdevelopment,emotionalwell-beingandreadinesstolearn”.Thedraftstrategyalsoidentifiesthefollowingissues:■ identifyingbestpractice■ earlyinterventionwherenecessary■ tacklingbarrierstolearning■ developingstronglinkswithfamiliesandcommunities

Thedraftstrategyalsoproposesreviewingthepre-schoolcurriculum,reflectingthecentralityofthecurriculumtoliteracyandnumeracy.Italsoproposessettingoutthemilestonestobeexpectedinachild’sdevelopment.

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In2012theDepartmentaskedtheEducationandLibraryBoards,inpartnershipwiththeothereducationalmanagementbodiestoproduceanauditofallschoolsandproduceplansforthefutureofthepost-primary(endofMarch2012)andprimary(endofJune2012)sectors.Thisislikelytoresultintheclosureofbothprimaryandpost-primaryschoolsinLisburn,andelsewhere.

LiteracyandNumeracyIn2011theGovernmentpublisheditsstrategytoimproveoutcomesinliteracyandnumeracy,Count,read:succeed.Amongstothermeasurestosupportpupils,teachers,schoolleadersandgovernors,includingthedevelopmentofguidanceforparentsrepre=schoolchildrenthestrategyhighlightstheimportanceof“earlyinterventionwherenecessaryforpupilsofanyage,informedbytheeffectiveuseofdata,toaddresstheneedsofthosewhoarestruggling”,especiallyintheearlyyearsand“ensuringearlyinterventiontoaddressactualorpotentialunderachievement”.TheActionPlanstatesthat“Extendedschoolswillensuretheirextendedschoolsactivitiesorservicesareintegratedintotheirplanningforraisingstandards.

ThestrategysaysthataDirectoratewillbecreatedinDElinkingwithparents,familiesandcommunitiestohelpthemsupporttheirchildren,particularlyinnumeracyandliteracy.

ChildcareTheDepartmentofEducationhasalsocommittedtoproducingaChildcareStrategyfor0-6yearsoldsandhascarriedoutaconsultationprocess.

4.5Area-basedInitiatives

NeighbourhoodRenewalInJune2003,GovernmentlaunchedPeopleandPlace–AstrategyforNeighbourhoodRenewal.Thislongterm(7–10year)strategytargetsthosecommunitiesthroughoutNorthernIrelandsufferingthehighestlevelsofdeprivation.NeighbourhoodRenewalisacrossgovernmentstrategyandaimstobringtogethertheworkofallGovernmentDepartmentsinpartnershipwithlocalpeopletotackledisadvantageanddeprivationinallaspectsofeverydaylife.Neighbourhoodsinthemostdeprived10%ofwardsacrossNorthernIrelandwereidentifiedusingtheNobleMultipleDeprivationMeasure.Followingextensiveconsultation,thisresultedinatotalof36areas,andapopulationofapproximately280,000(onepersonin6inNorthernIreland),beingtargetedforintervention.Theareasinclude:■ 15inBelfast,■ 6inLondonderryand

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■ 15inothertownsandcitiesacrossNorthernIreland(includingColinincorporatingPoleglassandTwinbrook).

NeighbourhoodPartnershipshavebeenestablishedineachNeighbourhoodRenewalAreaasavehicleforlocalplanningandimplementation.EachNeighbourhoodPartnershipincludesrepresentativesofkeypolitical,statutory,voluntary,communityandprivatesectorstakeholders.Together,theyhavedevelopedlongtermvisionsandactionplansdesignedtoimprovethequalityoflifeforthoselivinginthearea.

ThekeystrategicobjectiveofNeighbourhoodRenewalis:Totacklethecomplex,multi-dimensionalnatureofdeprivationinanintegratedway,throughthefollowing:■ CommunityRenewal-todevelopconfidentcommunitiesthatareableand

committedtoimprovingthequalityoflifeintheirareas■ EconomicRenewal-todevelopeconomicactivityinthemostdeprived

neighbourhoodsandconnectthemtothewiderurbaneconomy■ SocialRenewal-toimprovesocialconditionsforthepeoplewholiveinthe

mostdeprivedneighbourhoodsthroughbetterco-ordinatedpublicservicesandthecreationofsaferenvironments

■ PhysicalRenewal-tohelpcreateattractive,safe,sustainableenvironmentsinthemostdeprivedneighbourhoods.

NoneofthetargetareasinEarlyInterventionLisburnareconsideredtobeNeighbourhoodRenewalareas,basedonthe2001multipledeprivationdata.

AreasAtRiskTheAreas at RiskPilotProgrammewasestablishedin2006toidentifyandinterveneinareasconsideredatriskofslippingintoaspiralofdecline.TheDepartment,throughtheVoluntaryandCommunityUnit,inconjunctionwitharangeofotherpartners,willhelptosupportthesecommunities,whichperhapsfeelneglectedorisolatedinordertohelpbuildconfidenceandasenseofbelonging.Thetypesofareasthattheprogrammeoperateswithinincludeforexample:■ ‘Interface’areasthatlieoutsideofNeighbourhoodRenewalareas■ Areasineconomicdecline■ Areasat‘riskofdecline’forexample,thoseareasthatwithouttargetedsupport

maymoveintothetop10%asdefinedbyNoble■ Areasatriskof‘descendingintoinstabilityandcrisis’orareasinwhichthere

isadeclineincommunitycohesionwhichthreatenspeaceandstability■ Areaswherethelossoftheserviceprovidedbyorganisationswouldhavea

significantnegativeimpactonthelocalcommunity.

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ProgrammeObjectives-ThekeyobjectivesoftheProgrammeareto:■ reducethelevel,frequencyandimpactofinterfaceviolencewithinthe

community;■ increaselevelsofeconomicactivitywithinthetargetedareas;■ stabilisetargetedareastothepointthattheareaiseithernolongerconsidered

asan‘areaatrisk’,orthattheriskoftheareaslippingintodeclineisprevented;

■ increasecommunitycohesionandcapacity;■ strengthencommunityinfrastructureinthoseareaswhereitisweak;and■ achieveamoresustainableapproachtocommunityparticipationand

development.

Inordertoensurethatthecommunitiesparticipatinginthisprogrammemeetthecriteriaastrategicpartnershipwasestablished,chairedbytheVoluntaryandCommunityUnit.PermanentpartnersaretheDevelopmentOffices(BRO;RDO;NWDO)andtheNorthernIrelandHousingExecutive,inbothcasesinvolvementisdevolvedtolocaloffices.Otherstatutorybodiesareinvitedtojoinonanadhocbasisasandwhentheirexpertisewouldlendsignificancetotheprogramme.

Potentialareasforinclusionintheprogrammeweresoughtfromthepermanentpartners,whoalsohavetoprovideanevidentialbasisforinclusion.OthersourcesofreferenceincludedlocalpoliticiansincludingCouncillorsandMLA’s.EachnominatedareawasconsideredagainstcriteriabeforebeingsenttoMinisterforconsiderationandapproval.

Onceanareawasincludedalocalvoluntaryorganisationwasnominated(bythepermanentpartners)toactastheleadorganization,chargedwithassistingtocarryoutacommunityaudit.TheDepartmenttakestheleadinappointingaconsultanttocarryouttheauditwhichcanbesupportedthroughprogrammefunds,beforesubmittingaprojectproposal.Theprojectproposalwasconsideredbyallpartnerorganisationsandsubjecttounanimousagreement.

Thepilotprogrammeiscurrentlyoperatinginthefollowingareas:

Phase One: Sydenham(EastBelfast);Taughmonagh(SouthBelfast;Seacourt(Larne);WestPortadown;Rathenraw(Antrim);Dunclug(Ballymena;Limavady;DhuVarren(Portrush);Ballynashallog(Londonderry)

Phase Two: (Announced13November2007byMinisterMargaretRitchie):LowerWhitewell(NorthBelfast);Ballybeen(Dundonald);Gilford(Banbridge);Annadale(SouthBelfast);Scrabo(Newtownards);Killicomaine(Portadown);Alexander/Lisanally(Armagh);AshfieldGardens(Fintona);SeymourHill(Dunmurry);

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CraigyhillandAntivlle(Larne);Harryville(Ballymena);Caw/NelsonDrive/LincolnCourts(Derry/Londonderry)

Phase Three: (Announced28January2009byMinisterMargaretRitchie):Beechfield(Donaghadee);Lettershandoney(Derry/Londonderry);Strathfoyle(Derry/Londonderry);FerrisPark(LarneTown);DouryRoad(Ballymena).

NoneoftheEarlyInterventionLisburntargetareashavebeendesignatedasAreasAtRisk.

CommunitySafetyStrategyInJanuary2011thenewDepartmentofJusticeissuedforconsultation“Buildingsafer,SharedandConfidentCommunities–aconsultationonanewcommunitysafetystrategyforNorthernIreland”designedtohelpbuild:■ Safercommunities:withlowerlevelsofcrimeandanti-socialbehaviour,

includingsupportingearlyinterventionforlong-termcrimereduction■ Sharedcommunities:whereeveryone’srightsarerespectedinashared,and

cohesivecommunity■ Confidentcommunities:inwhichpeoplefeelsafeandhaveconfidenceinthe

justiceagenciesthatservethem

Thedraftprinciplesfordeliveringthestrategyincludeboth■ early intervention,“recognizingtheimportanceofearlyinterventionsto

helpaddresstheunderlyingriskfactorsthatcanleadtocrimeandanti-socialbehaviour”;and

■ Evidence-based solutions,“focusingonsolutionsthatpreventandreducecrimewhichareevidence-based,innovativeandresponsivetolocalneeds.

InordertobuildsaferCommunitiesthestrategywould“buildonwhatworksinreducingandpreventingcrime,andworkingreaterpartnershipwithotherExecutiveDepartmentstocreatesafercommunitiesoverthelongtermparticularlyintheareasofhealth,educationandaddressinginequalityandsocialdisadvantage”.

Section5.4outlinestherelationshipbetweencrimeandtheunderlyingcausesandriskfactorsandtherationaleforanearlyinterventionapproach.Itprovidestwoevidence-basedearlyinterventionapproachesincludingthePerryPreschoolProject.

ThedraftstrategycommitstheDepartmentofJusticeto“workwithotherExecutiveDepartmentstoconsiderhowwecansupportearlyinterventionandpromoteitatlocalpartnershiplevelwhereappropriate.Wewillcontinueto

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supportanddevelopearlystageinterventionprojects,andreviewwhatworksinearlystageprovision.

TheDepartmentofJusticehasdevelopedaStrategicFrameworkforReducingOffendingwhichwillbegoingoutforconsultationbeforetheSummer2012forapprovalbytheendoftheyear.Thisframework,amongstotherthings,highlightstheimportanceoftacklingsocialdeterminantsofcrimesuchasimprovingeducationalattainmentandreducingpoverty,aswellaspreventionanddiversionactivitiesincludingEarlyInterventions,tacklingdrugsandalcoholmisuseandrespondingtomentalhealthissues

4.6ProgrammeforGovernment2011–2016InMarch2012theGovernmentlauncheditsProgrammeforGovernment(PfG),followingaperiodofconsultation.TheProgrammehasfiveaims:■ Growingasustainableeconomyandinvestinginthefuture■ Creatingopportunities,tacklingdisadvantageandimprovinghealthand

wellbeing■ Protectingourpeople,theenvironmentandcreatingsafercommunities■ Buildingastrongandsharedcommunity■ Deliveringhighqualityandefficientpublicservices

TheProgrammecontainsthefollowingrelevantcommitments:■ Introduceandsupportarangeofinitiativesaimedatreducingfuelpoverty

acrossNIincludingpreventiveinterventions■ Provide£40milliontoimprovepathwaystoemployment,tacklesystemicissues

linkedtodeprivationandincreasecommunityservicesthroughtheSocialInvestmentFund(in8regionsofdisadvantageandpoverty)

■ Publishandimplementastrategyforintegratedandaffordablechildcare■ Deliverarangeofmeasurestotacklepovertyandsocialexclusion,throughthe

DeliveringSocialChangedeliveryframework■ UsetheSocialProtectionFundtohelpindividualsandfamiliesfacinghardship

duetothecurrenteconomicdownturn■ FulfillourcommitmentsundertheChildPovertyActtoreducechildpoverty■ Improvecommunitysafetybytacklinganti-socialbehaviour■ Increasetheproportionofyoungpeoplewhoachieveatleast5GCSEsatA*-C

orequivalentincludingGCSEsinMathsandEnglishbythetimetheyleaveschool

■ Improveliteracyandnumeracylevelsamongschoolleavers,withadditionalsupporttargetedatunderachievingpupils

■ Ensurethatatleastoneyearofpre-schooleducationisavailabletoeveryfamilythatwantsit

■ Allocateanincreasingpercentageoftheoverallhealthbudgettopublichealth

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■ Invest£7.8millioninprogrammestotackleobesity■ Provide£40milliontoaddressderelictionandpromoteinvestmentinthe

physicalregenerationofdeprivedareasthroughtheSocialInvestmentFund.

TheProgrammedoesnotspecificallyincludeacommitmenttoearlyinterventionortoevidence-basedapproaches.InFebruary2012theChildren’sCommissioner’s(NICCY)responsetotheDraftProgrammeforGovernmentrecommendedincludingaspecificcommitmentinthePfG“toearlyinterventionandpreventionforchildrenandyoungpeople,linkingfundingandjointworkingacrossdepartments”.

SocialInvestmentFundTheExecutiveagreedon22March2011totheestablishmentoftheSocialInvestmentFund(SIF)andmoniestotaling£80millionoverafouryearperiodweresubsequentlyallocatedintheBudget.thePfG,highlightedabove,includesarenewedcommitmenttotheFund.

ThehighlevelaimoftheSocialInvestmentFundistoreducepoverty,unemploymentandphysicaldeteriorationinareasthroughareabasedinterventionsofsignificantscalewhichwillbedeliveredinpartnershipwithcommunities.TheFundwilltoencouragecommunities,statutoryagencies,businessanddepartmentstoworktogetherinaco-ordinatedway,reducingduplication,sharingbestpracticeandenhancingexistingprovisionforthebenefitsofthosecommunitiesmostinneed.

TheSIF’sstrategicobjectivesaretosupportcommunitiesto:■ buildPathwaystoEmployment;■ tacklethesystemicissueslinkedtodeprivation;■ increasecommunityservices;and■ addressdereliction.

A“prediscussion”paperwaspublishedinMarch2011andoutlinesthehighlevelstrategicconcept,objectivesandoverallmethodologyoftheFund.AconsultationdocumentwaspublishedtoseekviewsontheproposedoperationoftheSocialInvestmentFund(SIF),includingoptionsforapplyingtotheFund,application/assessmentcriteria,howtheFundshouldbemanagedandthestructurestosupportitsdelivery.TheConsultationontheproposedoperationoftheSocialInvestmentFund(SIF)closedonthe23December2011.

SocialProtectionFundTheNIExecutivehasalsoestablishedaSocialProtectionFund(SPF)to“assistthosemostinneedinthewidercommunity”.Thisyear(2011/12)theyagreed

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toprioritisefuelpovertythroughthefund,andcommittedthefull£20millionbudgettoawinterfuelpovertypaymentschemethroughtheDepartmentforSocialDevelopmentandtheDepartmentofHealth,SocialServicesandPublicSafety(DHSSPS)undertheFinancialAssistanceAct(NorthernIreland)2009.Throughthescheme,aone-offpaymentof£75hasbeenmadetopersonsinreceiptofincome-basedmeans-testedbenefits,includingincomesupport,income-relatedemploymentandsupportallowanceandincome-basedjobseeker’sallowance.PensioncreditrecipientsandpeopleinreceiptofcancertreatmentinlinewithcriteriadeterminedbyDHSSPSarereceivingone-offpaymentsof£100.Althoughfundingfortheprogrammewassecuredforonlyonefinancialyear,theExecutivearecommittedtosecuringmoneysforfutureSPFprogrammesduringtheremainderofthecurrentBudgetperiod.

4.7ConclusionsinrelationtothePublicPolicyContextThepublicpolicycontextpresentsaconsistentsenseoftransitiontowardsanearlyinterventionandevidence-basedapproachtoaddressingmanyofthedifficultiesfacingchildren,youngpeopleandfamiliesinNorthernIreland.Thereisaclearunderstandingoftheimplicationsofdeprivationandwiderinequalitiesfortheoutcomesforchildrenandyoungpeopleandastatedcommitmenttotacklingtheseinequalities.Thepolicycontextsuggeststheprinciplesthatshoulddrivethisearlyinterventionapproachareasfollows:

Interventionsshould:■ focusontacklingrootcausesandnotjusttreatingsymptoms;■ takeplaceintheearlyyearsofachild’slife,where,theevidencesuggests,

manyproblemsinlaterlifearecreatedandatwhichstagebraindevelopmentismoulded,and/orattheearlieststageofdifficulty,whenachildmaybevulnerabletopoordevelopmentaloutcomes;

■ adoptawholechildapproach,whichgivesrecognitiontothecomplexnatureofourchildren’sandyoungpeople’slives;

■ adoptawholefamilyapproachwhichconcentratesonallmembersofthefamily-children,youngpeople,andtheirparentsandsupportingfamilylife;

■ adoptawholesocietyapproachtoearlyinterventionthroughanetworkofintegratedsupportsandservicesandmulti-agencyworking;

■ buildonthestrengthsandresilienceofchildren,youngpeopleandfamiliesandnotonlyrespondtotheirneeds;

■ beevidence-basedthroughimplementingprogrammeswhichhavebeensubjecttorigorousevaluation(esp.RCTs).Innovationsthathavenotbeenrobustlyevaluatedbeforeshouldberigorouslyevaluated;

■ befocusedonachievingclearmeasurableoutcomes;■ Beimplementedwithfidelitybyskilledandtrainedstaff;■ be“owned”bythecommunitythroughacommunitydevelopmentapproach;

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■ beaccessibleandpromoteparticipationandinclusion;■ besustainedandlong-term;■ combine

• Level1support:universal(allchildren);• Level2support:targetcommunitiesandgroups/categoriesoffamilies

whicharemostvulnerableduetodeprivation,etc.;and• Level3support:non-stigmatisingtargetedearlyinterventiononparticular

familiesassessedtobemostatrisk.

Thepolicycontextraisesotherimportantissuestobeconsidered:

IdentificationofareasofdeprivationTherecognitionoftheimportanceofdeprivationindeterminingoutcomesforchildrenandyoungpeoplehasresultedinthedevelopmentofthevaluableMultipleDeprivationMeasure(MDM)torankwardsandSuperOutputAreas.Thishasbeenusedbyarangeofinitiativestotargetthose“mostinneed”.NeighbourhoodRenewalhasfocusedawiderangeofservicesandresourcesinthe10%ofmostdeprivedcommunities(basedonthe2001MDM.Thisapproachhassignificantshortcomings,including:

■ ThemajorityofpoorfamiliesliveoutsideNeighbourhoodRenewalareas■ ManybetterofffamiliesliveinthemostdisadvantagedSOAs■ Resourcesavailabletocommunitieswhichrankjustoutsidethe200110%

rankinghavebeendivertedtowardsNeighbourhoodRenewalAreas■ Deprivationchangesovertime.Ifcalculatednow,OldWarrenwouldbea

NeighbourhoodRenewalArea■ MDMincludesproximitytoahospital,inthiscase,LaganValleyHospital

whichisveryclosetoTonagh/OldWarren/Knockmore,butisnolongerafullacutehospital

■ AveragingDeprivationthroughanaggregatemeasuresuchasMDMignorestheimportanceofindicatorswhichmayshowaverydifferentpicture.Forexample,theverylowlevelofeducationalattainmentinProtestantworkingclassareasinLisburn(andotherpartsofNorthernIreland)isverydisturbing,requiringurgentaction,butismaskedbyafocusedonMDM.

ResourcingandImplementationManyofthestrategiesaboveexpressagoodunderstandingoftheissuestobeaddressedverypositiveaimsandprinciples.However,thelong-termresourcingandimplementationhasbeenpoor.Despitethesepositivesoundingstrategydocuments,littlehaschangedfordisadvantagedfamiliesinthetargetareasofLisburncharacterisedbypovertyand,evenmoreso,byeducationalunderachievement.Manyevidence-basedinitiativeshavebeenintroducedina

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half-heartedwaywithinadequateand/orshort-termresources.Thereneedstobeaclearcommitmenttoeffectivelong-termresourcingofrobustlyevidence-basedprogrammes,otherwisetheinequalitieswillcontinuetowiden.

Theeconomicevidencethatearlyinterventionprogrammescan,ratherthancostmoney,overthelonger-term,saveconsiderableamountsofmoneyforthestate,butthenatureofshort-termfundingdecisionsmeansthatthecriteriausedtomakethesedecisionsdonottakeintoaccounttheselong-termsavings.

PartnershipworkingThemantraofcross-sectoralandintegratedpartnershipworking,basedonawholechildmodel,cannotbedeliveredthroughtraditionalsilomodelsandstructures.EarlyInterventionoftenmeansinvestmentsbyoneDepartmentoragencyinordertoproducedesiredoutcomesforadifferentDepartmentoragency.

Hopefully,thenewChildrenandYoungPeople’sStrategicPartnershipandthesub-regionalOutcomeandLocalityGroupspresenttheopportunitytomakeaseriouscommitmenttopartnershipworkinganddevelopingtrulyintegratedservices.

Thereisstillabiggapbetweentheworkofpublichealthandsocialcareagenciesandworkinschools.TheExtendedSchoolsinitiativehasmadeasmallcontributiontowardsmoreintegration,butthisisonlyattheearlystages.Forearlyinterventiontobesuccessfulthereneedstoseamlessworkingbetweenschools(whichnearlyallchildrenattend),community-basedinitiatives,andthehealthandsocialcaresector.

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5.1OutcomesTheprevioussectionshave:■ analysedtheneedsofthetargetcommunitiesinLisburn,asidentifiedbothby

deskresearchandthroughtheconsultationswithcommunityrepresentatives,schoolsandthosefromtherelevantprofessionalagenciesworkingintheareas;

■ examinedtheconcepts,andrationale,aroundearlyintervention;and■ summarisedtherelevantpublicpolicycontext.

These,together,suggestthatthespecificoutcomeswhichtheEarlyInterventionLisburnInitiativeshouldtarget,tohaveanimpactontheGovernment’shighleveloutcomesforchildrenofbeing:Healthy;Enjoying,learningandachieving;Livinginsafetyandwithstability;Experiencingeconomicandenvironmentalwellbeing;Contributingpositivelytocommunityandsociety;andLivinginasocietywhichrespectstheirrights,shouldbeasfollows:

■ Reducednumberofteenagepregnancies■ Reducedlevelofsmokingduringpregnancy■ Improvedparentingskillsandconfidence■ Improvedparent-childattachmentfor0-2yearolds■ Improvedschoolreadinessamongst3&4yearolds■ Improvedliteracyandnumeracyinchildrenaged4-11■ Improvedsocialandemotionalskillsandresilienceof4-11yearolds■ Improvedschoolattendance■ Improvededucationalaspirationsandattainmentonleavingschool■ Reducedbehavioural/conductproblems■ Reducedsmoking,alcoholanddrugconsumptionamongstyoungpeople■ Reducedcrimeandanti-socialbehaviouramongstyoungpeople■ Reducedchildhoodandteenageobesity■ Increasedengagementoffathersintheirchildren’slearning

Thereisbroadagreementthattheseareimportantoutcomestobeaddressedtoimprovethelivesofthepeopleofthetargetareas.However,thekeyquestionishowbesttoachievetheseoutcomes.Thisinturnsuggestsanumberofotherquestions,whichneedtobeaddressed,asfollows:

■ Whatimpactdocurrentprogrammesandservicesmakeontheseoutcomesandhowcouldtheymakeagreaterimpact?

■ Whatarethemosteffectiveinterventionstoachievetheseoutcomes?andhowrobustistheevidenceforthepotentialimpactoftheinterventions?

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■ Whatarethemostcost-effectiveinterventionsi.e.whichinterventionswillcreatethegreatestlong-termsavingstothepublicpurse?

■ Whichinterventionsshouldbeuniversal,targetedonparticularcommunities/populations,ortargetedonparticularfamilies?

■ Whereshouldinterventionstakeplace:inthehome,communityvenuesand/orschools?

■ Howcanprogressagainsttheagreedoutcomesbemeasured?

■ Whatresourcesarerequiredtoimplementtheevidence-basedprogrammesthatwillhaveasignificantimpactontheagreedoutcomes?

5.2AligningexistingprogrammesandservicesAlthoughLisburnisunderservedintermsofsupportforchildrenandfamilies,asitdoesnotreceiveregenerationfundingsuchasNeighbourhoodRenewal,despitehavingareaswithinthe10%mostdeprivedinthe2010MDMfiguresandconsiderablyworseeducationaloutcomesthanmanyotherareaswithintheworst10%,therearesomeexistingservicesandprogrammesthatoperateinoneormoreofthetargetareas,deliveredbydifferentstatutoryandvoluntaryagencies.Asafirststepitwillbeimportantto:■ increasetheawarenessof,andfocuson,preventionandearlyintervention;■ mapandimprovetheco-ordinationandintegrationofexistingservicesfor

childrenandfamilies,towardsachievingtheagreedoutcomes;■ supportexistingcommunityservicesforchildren,youngpeopleandfamilies

intheLisburnareabydevelopingacommonoutcomesframework(whichwillenableimpacttobemeasured);

■ helpprogrammes/servicestosetandmeasurespecificoutcomes;learnfromtheinternationalliterature;andmanualiseprogrammes/services;

■ developasharedfocusonqualityachievedthroughjointreflectivepractice,trainingandpeerlearning,wherebydifferentorganisationscanlearnfromoneanother;and

■ encourageandsupportexistingorganisationstoworktogethertotransformtheculturewithintheCityofLisburn,especiallywithinareasofdeprivation,toemphasiseaspirationandachievement(particularlyinrelationtoeducation).Thiscanbedonethroughlocalmedia,doortodoorconsultations,celebratinglocalchampionsetc.

5.3WhatWorks?Therehasbeenextensiveworkcarriedoutaroundtheworldtoevaluatewhichofthemanyearlyinterventionsocialprogrammesactuallyworki.e.havea

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Theory of change

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significantpositiveimpactonthedesiredoutcomes.Thestrongestevidenceisfromevaluations,carriedoutbyexperiencedindependentevaluators,whichinvolvelargenumbersofchildren,familiesand/oryoungpeoplereceivingamanualised(standardised)programme;wherethereisaRandomControlTrial(RCT)witharandomisedcontrolgroupnotreceivingtheprogrammewhichisthereforeverysimilartothegroupreceivingtheprogramme;andtestingiscarriedoutbothbeforeandaftertheintervention,usingwell-establishedmeasurementinstruments.

Therearevariousorganisationsinternationallywhichspecialiseinanalysingthequalityandrobustnessofevaluationinformationfromsocialprogrammesaroundtheworldinordertohighlightprogrammeswhichare“proven”or“promising”,includingBlueprintsandtheWhat Works Clearing House.WorkisnowunderwaytodevelopanequivalentoftheBlueprintsdatabaseforEurope.DartingtonSocialResearchUnitinEnglandhaveworkedwithSteveAosfromWashingtonStateUSAtocreateacostbenefitmodelforEnglandwhichwillformpartofasoontobelaunched“BlueprintsforEurope”(seehttp://www.dartington.org.uk/investinginchildren).GrahamAllenMP,inhisreports,hashighlightedtheprogrammeswhichhehasbeenadvisedbyUKexpertshavethestrongestevidencebase.

Theimpactofsomeofthebestprogrammeshasalsobeenevaluatedintermsofthelong-termcostsandbenefits.Thesehaveshownthatinvestmentintherightevidence-basedearlyinterventionprogrammescanproduceverysubstantiallonger-termsavingsinissueslike:welfarebenefits,medicalandmentalhealthservices,prisonandotherjusticeservices,etc.ThismeansthatfortheGovernmentinNorthernIrelandtoinvestintherecommendedprogrammesinLisburnislikelytoresultinlong-termsavingsmanytimestheamountoftheinvestmentthatisrequirednow.

NobellaureateeconomistJimHeckmanhasanalysedalargenumberofcost-effectivenessstudiesandshownthattheyoungertheageofchildrenengagedintheprogrammesthemoreeffectivetheyareinreducinginequalitiesandmorecost-effectivetheprogrammesareingeneratinglong-termsavings.ThissuggeststhatthebedrockoftheEarlyInterventionLisburnprogrammeshouldbefamilyinterventionsfrompregnancytoage3.Hissubsequentwork,however,alsoshowsthattheseinterventionsneedtobesustainedasthechildrengetolder,particularlyduringtheirprimaryschoolyears,topreventinequalitiesbeingstrengthenedagain.Thisindicatestheimportanceofprogrammesthataddresstheneedsof3-11yearoldsandthosewhomakethedifficulttransitiontopost-primaryschool,aswellasthecrucialprogrammesforchildrenaged0-3andtheirparents.

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5.3ProvenEarlyInterventionProgrammesWhatworksinmeetingthecomplexneedsoffamiliesisarangeofapproaches.Inordertogiveanindicativelistofpotentialprogrammes,thefollowingaresomeofthemostrobustlyevaluated“proven”programmes(i.e.havebeensubjecttoatleasttworobustRCTevaluationswhichproducedstatisticallysignificantresults)mostofwhichhavebeenshowntoresultinsubstantiallatersavings,inrelationtoeachoftheimportantoutcomesforEarlyInterventionLisburn,highlightedabove:

Reducednumberofteenagepregnancies■ FamilyNursePartnership*(pregnancy–age2)–deliveredbyatrained

healthvisitororothernursetotargetedparentsinthehome–whichhasbeenshowntoreduceanddelaysubsequentbirths–ItiscurrentlybeingdeliveredinNorthernIrelandbytheWesternHealth&SocialCareTrustinDerry/Londonderryand,althoughPHAidentifiedLisburnasapriorityareaintheSouthEast,BelfastandtheSouthernTrustareashavebeenchosenfornewFamilyNursePartnershipprogrammes,ratherthanLisburn.ItisalsobeingdeliveredinScotlandinEdinburghandTaysideandinEnglandbyNottinghamlocalauthority.ThereiscurrentlyamajorRCTtrialbeingcarriedoutonFamily

0-3 4-5pre-school

School Post-school

Preschool programs

Schooling

Programmes targeted towards the earliest years

Age

Job training

Rat

e of

Ret

urn

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Inve

stm

ent

in H

um

an C

apit

al

* KnownasNurseFamilyPartnershipsintheUSAwheretheprogrammeoriginated

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Theory of change

The Hockman Curve

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NursePartnershipsinGB.Previousevaluationsshowthattheparentandchildprogrammescombinedaremoreeffectthaneitherdeliveredontheirown.

Reducedlevelofsmoking,drinkinganddruguseduringpregnancy■ FamilyNursePartnership(pregnancy–age2)–seeabove

Improvedparentingskillsandconfidence■ IncredibleYears(aged0-9)ParentsProgramme:Basic(12-14weeks);Advanced

(10-12weeks);andSCHOOLandDinaDinasaur(anhourtwiceaweek(ortwohoursonceaweekfor20-22weeks)forchildrenwithconductproblems)–Targetedonidentifiedfamilies–ItiscurrentlybeingdeliveredintheRepublicofIreland(Youngballymun/Archways)andvariousaspectsofIncredibleYearsisbeingdeliveredinvariousplacesinNorthernIreland(IFIarefundingacross-communityinitiativeintheSEELBareatodeliverIncredibleYearsin16schools,includinginOldWarrenPrimarySchool)

■ Parent-ChildInteractionTherapy(age2-7yearolds)–Targetedonpre-schoolchildrenwithevidenceofaconductdisorderandtheirparents

Improvedparent-childattachmentfor0-2yearolds■ FamilyNursePartnership(pregnancy–age2)–seeabove

■ IncredibleYears(aged0-12)–seeabove

Improvedliteracyandnumeracyinchildrenaged4-11■ DoodleDen–aliteracyprogrammefor5/6yearolds,withadditionalparent

andfamilysessions.Itisdeliveredfor90minutesthreetimesaweekafterschool(inschoolandcommunityvenues)byaspeciallytrainedteacherandyouthworkertoagroupof15children.TheRCTofthepilotinWestTallaghtDublinhasdemonstrateditsimpact.

■ SuccessforAll,includingCuriosityCorner(age3-11yearolds)–Universal-school-based-InstituteofEffectiveEducationUniversityofYork.Therearemodulesforeachkeystagefromfoundationtokeystage3

■ TimetoRead(age8–10yearolds)–developedinNIbyBusinessintheCommunity,usingvolunteersfromcompaniestoreadfor30minuteseachweekwithchildreninaprimaryschoolsetting.Arandomcontroltrialevaluationhasindicateditseffectiveness,esp.forthosechildrenwhosereadingdevelopmentisonlyslightlydelayed.ReadingRecoveryislikelytobemoreeffectiveforthelowest20%ofreaders.TimetoReadisfreetotheschools.ThekeyissueisBITCbeingabletoidentifyappropriatevolunteerstodeliverthe

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programme.ItisalreadybeingdeliveredinOldWarrenandKillowenPrimarySchools

Improvedsocialandemotionalskills,conductandresilienceof4-11yearolds■ PATHS(4/5-11yearolds)–Universal-school-based–Barnardo’sinNorthern

Ireland(aroundCraigavon)andlocalauthoritiesinBirmingham,NorfolkandManchester

■ IncredibleYearsforchildren,parents(seeabove)andteachers(6daytrainingworkshoponclassroombehaviourmanagement)–seeaboveandAppendixfordetails

Reducedbehavioural/conductproblems■ IncredibleYears(aged0-12)–childprogramme(incDinaDinosaur)–universal

preventionprogrammeandtreatmentprogrammeforsmallgroupsofparticularlyatriskchildren–seeaboveandAppendixfordetails

■ TripleP(aged0-16)–Bothuniversalandtargeted(4levels)–onlyprovenifthewholeprogrammeatthe4levelsisdelivered(onlya“promising”BlueprintsProgramme).IsbeingpilotedinLongfordWestMeathParentingPartnershipintheRepublicofIrelandandEngland

Improvedschoolattendance■ BigBrothers/BigSisters(6-18yearolds)–Targeted-mentoringdeliveredby

carefullyselectedandtrainedvolunteers–beingdeliveredinvariouspartsoftheRepublicofIrelandthroughForoige.

Reducedsmoking,alcoholanddrugconsumptionamongstyoungpeople■ BigBrothers/BigSisters(6-18yearolds)–seeabove

■ LifeSkillsTraining(9-15yearolds)–Universal–3-yearschool-basedprogramme(15sessionsinyear1;10inyear2;and5inyear3)–currentlybeingdeliveredinNottingham.Barnardo’shaveBigLotteryfundingtodeliverLSTintheUK,includingNorthernIreland

■ FunctionalFamilyTherapy(10-18yearolds)–Targeted-family-based–deliveredbyaspeciallytrainedqualifiedsocialworker-currentlybeingdeliveredbyArchwaysinDublinandbeingtrialedinBrighton.ActionforChildrenareplanningtodeliveritinNorthernIrelandwithBigLotteryfunding

■ Nurse-FamilyPartnerships–seeabove

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Reducedcrimeandanti-socialbehaviouramongstyoungpeople■ Nurse-FamilyPartnerships–seeabove

■ FunctionalFamilyTherapy(10-18yearolds)–seeabove

■ MultisystemicTherapy–Targetedonatriskyoungpeople(aged12-17)-familyandcommunity-based.ExternhavebeenpilotingMSTinNorthernIrelandandareplanningtoexpandtheprogrammewithfundingfromtheBigLottery

Increasedengagementoffatherswiththeirchild’slearningNo“proven”programmes.TheUSprogrammeFather’sReadingEveryDay(FRED)looksasifithaspotentialandengagesLibrariesinearlyintervention.AllagreedprogrammesshouldfollowtheFatherhoodInstituteguidelinesonengagingfathers.

Improvededucationalattainmentonleavingschool■ BigBrothers/BigSisters(6-18yearolds)–seeabove

Reducedchildhoodandteenageobesity■ Therehavebeenfewstudiesthathavedemonstratedeffectivenessin

preventingobesity.Effortstotackleobesityinschoolhavehadpoorresults.Thefocusofcurrentresearchisontheante-natal,post-natalandpre-schoolperiods.SureStartseemstohaveanimpactonchildren’sBMIbutnotonthelevelofobesity.PHAareinvolvedinarangeofprogrammestotryandimprovephysicalfitnessandreduceobesity

OtherProgrammesThereareotherprogrammeswhichaddresstheoutcomeshighlightedabove,buttheylacktherobustevidence-basetobeconfidentthatimplementingtheseotherprogrammesinLisburnwouldhaveasignificantimpactontheagreedoutcomes.

OtherpopularprogrammesarealreadybeingdeliveredinLisburn,includingtheNewParentingProgramme,ParentInfantProgramme(PIP)andMellowParents/Fathers/Bumps.TherearealsoanumberofyouthworkprogrammesinthetargetareasofLisburn.TheEarlyInterventionapproachdoesnotmeanthatthese“unproven”programmesshouldimmediatelybeabandoned,unlesstherearealternative“proven”programmesthatcanreplacethem,butthat,wheretheyarealreadymanualised,deliveredtoasignificantnumberofchildren/familiesandfocusedonspecificoutcomes,theyshouldberobustlyevaluatedusinganRCTmethodologyassoonaspossible.Othercurrentprogrammeswhicharenotyetatthisstageofdevelopment,suchasyouthwork,shouldbefurtherdeveloped,usingtherobustinternationalresearchevidence,tocreatemoreclearlydesired

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outcomes,andbemanualisedandevaluated.ThecurrentpartnershipwiththeUniversityofUlstershouldassistinthisprocess.

SureStartSureStart,whichisakeyGovernmentearlyinterventionindisadvantagedcommunitiesandwhichcurrentlyoperatesinOldWarrenandHillhall,hasnotyetbeendiscussedinanydetailinthisreport.

SureStartisagovernmentledinitiativeaimedatgivingeverychildthebestpossiblestartinlifeandwhichoffersabroadrangeofservicesfocusingonFamilyHealth,EarlyYearsCareandEducationandImprovedWellBeingProgrammestochildrenaged4andunder.TheSureStartProgrammeissupportedbyanumberofkeyprinciples:■ Toco-ordinate,streamlineandaddvaluetoexistingservicesforyoung

childrenandtheirfamiliesinlocalcommunities■ Toinvolveparents■ Toavoidstigma■ Toensurelastingsupport■ Tobesensitivetolocalfamiliesneeds■ Topromotetheparticipationofalllocalfamilies

Servicesprovidedbyprojectsmust:■ Addvaluetoexisting/plannedservices■ Bebaseduponevidenceofwhatinterventionsaresuccessful■ Imaginativelyrespondtolocalneed■ Beinformedbystrategicdirection

SureStartworkisfocusedon6highleveloutcomestoensurechildrenare:■ BeingHealthy■ EnjoyingLearningandAchieving■ LivinginSafetyandwithStability■ LivinginaSocietywhichRespectstheirRights■ ExperiencingEconomicandEnvironmentalWell-being■ ContributingPositivelytoCommunityandSociety

ThecoreservicesofSureStartare:■ OutreachandHomeVisitingServices-tomakecontactasearlyaspossiblein

thechild’slifeanddrawfamiliesintousingotherservices■ FamilySupportandParentingInformation-bothgroupandhomebased■ GoodQualityPlay,LearningandChildCareExperiences-forchildren,both

groupandhomebased■ PrimaryandCommunityHealthcareandAdvice

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■ SupportforChildrenwithSpecialNeeds-throughsignpostingtomorespecialisedserviceswherenecessary

Examplesofspecificservicesofferedthroughprojectsinclude:■ Homebasedantenatalcare■ BreastfeedingSupportGroups■ Advice,supportandinformationonhealthrelatedtopics■ EarlyLanguageDevelopmentProgrammes■ Playdevelopmentforallagesandstages■ Ageappropriatephysicaldevelopmentopportunities■ Highqualitycrèchesessions■ Promotionofthecreativearts■ Supportforsmoothtransitionsbetweenpreschoolandschool

SureStartservicesarecurrentlyavailableinatleastthetop20percentwardareasofdisadvantageinNorthernIreland,andthetop20percentSuperOutputareas,asdefinedbytheNorthernIrelandMultipleDeprivationMeasure2010.Therearenow34SureStartprogrammesacrossNorthernIrelandwhichcoverawidegeographicspreadandhaveagoodurbanandruralmix.Over30,000childrenagedunderfouryearsandtheirfamilieshaveaccesstotheservicesprovidedthroughtheprogramme.Outofthe32programmesoperatinghere,approximatelyone-thirdarebasedinruralsettings.

SureStartprogrammeshavebeendesignedspecificallytoreflectandrespondtolocalneeds.Forthatreason,eachSureStartprogrammeisuniqueintermsoftheservicesitprovidesandthemannerinwhichitprovidesthem.However,allSureStartprojectsnowprovideaDevelopmentalProgrammefortwotothreeyearoldswhichaimstoenhancesocialandemotionaldevelopment,buildoncommunicationandlanguageskillsandencourageimaginationthroughplay.Thiscanhelpsomechildrentobepreparedforstartingpre-schooleducation.TheProgrammeisnotintendedtobeauniversalserviceforallchildrenintheyearbeforestartingpre-schooleducationbutisaimedprimarilyatthosechildrenwhoarelikelytobenefitmostfromthissupport.

ThereisamajornationalevaluationoftheSureStartprogrammeinEngland,whichshouldproduceaclearerunderstandingoftheimpactoftheprogrammebytheendof2012.InterimevaluationshaveshownthatchildreninSurestartareasarelikelytohavebetterphysicalhealththantheequivalentnon-SureStartareas.Mothersalsoreportedprovidingamorecognitivelystimulatingandlesschaotichomelearningenvironmentfortheirchildren;experiencinggreaterlifesatisfaction;andengaginginlessharshdiscipline.Howeverthemothersalso

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reportedmoredepressivesymptomsandlessengagementwiththeirchild’sschool(althoughitwaslowoverallalready).

TheSureStartevaluator,onthebasisoftheinitialevidencehasrecommended,intheGrahamAllen2011EarlyInterventionreport(Allen2011),thatSureStart,deliveredtoahighstandard,shouldbeakeycomponentinanyearlyinterventioninitiative,althoughnotsufficientinitself.

ThereisalsoanimportantquestionastothenumberoffamiliesthatanyparticularSureStartschemewillbeabletosupportinlightofthefundingmadeavailable.Theevidence,highlightedabove,isthatthemajorityofchildreninthetargetareasofLisburnarelikelytosignificantlyunderachieveeducationally,withveryimportantimplicationsforotheraspectsoftheirlives.CurrentschemesinOldWarrenandHillhall(currentlypartoftheColinNeighbourhoodinitiative)canonlysupportaverysmallnumberoffamilies.IfSureStartistomakeasignificantimpactinthetargetareas,itneedstoreachamuchlargernumberoffamilieswithhighqualityservicesdeliveredbywelltrainedstaff.OnthecurrentDENIcriteria,TonaghshouldalsohaveaSureStartscheme.Fromthestatisticalevidence,oneducationalgrounds,thereisastrongcaseforalsohavingaSureStartschemeinHildenandLaganValley.

5.4CriteriatouseinselectingearlyinterventionprogrammestodeliverHavingsuggestedalong-listofevidence-basedprogrammeswhichwouldhaveanimpactonthedesiredoutcomes,itisimportanttobeclearaboutthecriteriathatwillbeusedtoselectasmallernumberofprogrammesfromthislist.Itisrecommendedthattheseshort-listingcriteriaareasfollows:

NumberofoutcomeseachoftheprogrammesislikelytohaveanimpactonEachoftheevidence-basedinterventionshighlightedabovehaveanimpactonadifferentnumberofthedesiredoutcomes.Allthingsbeingequal,priorityshouldthereforebegiventoprogrammesthathaveapositiveimpactonthelargestnumberofdesiredoutcomes.Thenumberofoutcomesthatwouldbeaffectedbythelong-listedprogrammesareasfollows:

ThereisevidencethataFamilyNursePartnershipprogrammecouldhaveapositiveimpactonatleastfiveofthedesiredoutcomes.

IncredibleYearsprogrammeforparents,childrenandteachersislikelytohaveanimpactonatleastfourofthedesiredoutcomes.

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BigBrothers/BigSistersislikelytohaveanimpactonatleastthreeofthedesiredoutcomes,includingschoolattendanceandeducationalattainmentwhichareclearlycriticaloutcomesinLisburn.

FunctionalFamilyTherapyislikelytohaveanimpactonatleasttwoofthedesiredoutcomes

Thefollowingprogrammesarelikelytohaveanimpactonatleastoneoftheoutcomesabove:■ PATHS■ Parent-ChildInteractionTherapy■ SuccessforAllincludingcuriositycorner■ TripleP■ LifeSkillsTraining■ MultisystemicTherapy■ DoodleDen■ TimetoRead

AgegrouptobeaddressedTheevidenceisthattheearliertheageoftherecipientsofaprogrammethemoreeffectiveandcost-effectiveitislikelytobe.However,itisalsoimportantthatprogrammestoenhancethelifechancesofdisadvantagedchildrenandyoungpeoplecontinueaftertheearlyyearsprogrammesthroughprimaryschoolandthetransitiontosecondaryschool.Thetargetagegroupsofeachoftheprogrammesareasfollows:

Frombirth:■ FamilyNursePartnership-pregnancy–age2(targeted–home-based)■ IncredibleYears-age0-12(community-basedinc.schools)■ TripleP-age0-16

Fromage2/3:■ SuccessforAll,includingCuriosityCorner-age3-11(universalinprimary)■ Parent-ChildInteractionTherapy-age2-7(targetedhome-based)

Fromage4-6■ PATHS–age4/5-11(universalinprimaryschools)■ BigBrothers/BigSisters–age6-18(targeted–community-based)■ DoodleDen–age5/6(targetedinprimaryschools)

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Fromage8-12■ TimetoRead–aged8-10■ LifeSkillsTrainingage9-15(universalinprimaryandpost-primaryschools)■ StrengtheningFamiliesage10-14(targetedhome-based)■ FunctionalFamilyTherapy–age10-18(targetedhome-based)■ MultisystemicTherapy-age12-17(targetedhome-based)

TheappropriatelocationofprogrammesEachoftheprogrammesaredesignedtobedeliveredindifferenttypesoflocations.Theabilityofonetypeofvenuetotakeonmorethanonenewprogrammeatatimewouldsuggestthatprogrammesshouldcoverarangeofdifferentvenues.Thesepotentialtypesofvenuesarehighlightedbelow:

Universalinprimaryschools■ PATHS(4/5-11yearolds)■ SuccessforAll,includingcuriositycorner(3-11yearolds)■ LifeSkillsTraining(9-15yearolds)

Targetedinprimaryschool■ TimetoRead(6-8yearolds)■ DoodleDen(5/6yearolds)

Universalinpost-primarySchools■ LifeSkillsTraining(9-15yearolds)

Targeted–basedinacommunityvenue(includingschoolsandlibraries)■ IncredibleYears(0-12)■ BigBrothers/BigSisters(6-18yearolds)

Targeted–home-based■ FamilyNursePartnership(pregnancy–2yearolds)■ Parent-ChildInteractionTherapy(2-7yearolds)■ FunctionalFamilyTherapy(10-18yearolds)■ MultisystemicTherapy(12-17yearolds)

CapacitytodeliverThechoiceofthemostappropriateinterventionsandthetimingoftheirintroductionwillalsodependonthelocalcapacitytointroduceanddelivertheprogrammewithfidelity.AprogrammedevelopedintheUSA,forexample,thathasneverbeenusedintheUKorIrelandislikelytoneedtobeadaptedinawaythatisappropriateforthelocallanguageandcultureandtheadaptationwillneedtobeapprovedbytheprogrammelicense-holder(s)oftheprogramme.Onthepositive

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sidethereisarapidlyincreasingskillandexperienceindeliveringarangeofevidence-basedprogrammesintheUKandIreland,includingNorthernIreland.

ProgrammesalreadybeingdeliveredinNorthernIreland■ IncredibleYears■ FamilyNursePartnerships■ PATHS■ Multi-systemicTherapy

ProgrammesalreadyplannedforNorthernIreland■ LifeSkillsTraining

ProgrammesalreadybeingdeliveredintheUKorIreland(inadditiontothosedeliveredinNorthernIreland,whichareallalsobeingdeliveredinUKand/orIreland)■ BigBrothers/BigSisters■ SuccessforAll■ FunctionalFamilyTherapy■ TripleP

Otherprogrammes■ Parent-ChildInteractionTherapy■ MultisystemicTherapy

Short-listedevidence-basedprogrammesTheaboveselectioncriteriawouldsuggestthatthemosteffectiveandpracticallydeliverableinterventionstoimpactonthedesiredoutcomesabovewouldbeasfollows:

■ IncredibleYears(parentandchildprogrammes-throughtheprimaryschoolswiththepooresttestresultsatstages1&2andthroughSurestart)

■ FamilyNursePartnerships■ BigBrothers/BigSistersmentoringprogramme■ PATHS■ LifeSkillsTraining■ MultisystemicTherapy■ SuccessforAll■ DoodleDen■ TimetoRead

Note:FunctionalFamilyTherapyandMultisystemicTherapyareeffectivelyalternativestoeachother.OncostgroundsMultisystemicTherapyisbeingrecommendedhere.

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Itisimportanttosaythattheamountofrobustevaluationevidence,bothpositiveandnegative,onprogrammesforchildren,youngpeopleandfamiliesisincreasingrapidly.WithintwoyearstherewillbeovertwentyRCTevaluationsofsuchprogrammesintheUKandIreland,whichwillfurtherenhancetheabilityofEILtoidentifythemostappropriateinitiativestoachievetheagreedoutcomes.Theshortlisted“proven”programmesrecommendedinthisreportarebasedonthecurrentbestevidence.ResurgamandEarlyInterventionLisburnSteeringGroup/Consortium,inconsultationwiththemainstakeholders/funders,willneedtomakefinaldecisionsastotheprogrammestoprioritiseinphase1,aswellascontinuingtoexaminetheemergingnationalandinternationalefficacyevidence(theCYPSPparticularlyrecommends*trackingtheoutcomesofRCTevaluationsinNorthernIreland);buildinglocalcapacity,sothatthereisanongoingsustainedefforttochangeoutcomesforchildren,youngpeopleandfamilies.;promotinginnovationandtheinclusionoflocalcommunities,childrenandyoungpeopleinbuildingontheirassets,promotingtheirrightsandrespondingtotheirneeds.

5.5CostsoftheEarlyInterventionProgrammesTheevidenceonthecostsofdeliveringthelong-listedevidence-basedprogrammesisasfollows:

Programme Target group Total cost** to deliverIncredibleYears

Parentsand3-8yearolds

Parentprogramme:£4,833perschooleachyear;SchoolReadiness(enhancedparentingprogramme):£1,500perschool;DinaChildren’sProgramme:£6,253perschool

£12,586perschool/venue(inc.all3IYSprogrammes)

PATHS 4-6yearolds Costof£10,000peryearperschool(totalcosts)

£10,000perschool

FamilyNursePartnership

Pregnancy–age2

Costof£3,000perclientfamilyperyear,inc.nursetraining

£669,000for10%offamiliesintargetareas

BigBrothers/BigSisters

6-18yearolds Costperyoungpersonperyearc.£627

£140,000for10%ofallchildrenaged6+inthetargetareas

LifeSkillsTraining

9-15yearolds Costofc.£4.40perstudentplusthecostoftraining:£2,508

£7,000.00forallyoungpeopleaged9-15

MultisystemicTherapy

12-17yearolds c.£2,821peryoungperson £282,100for10%ofyoungpeopleage12-17

SuccessforAll,includingcuriositycorner

3-11yearolds £3,467forKeyStage1and£7,280forKeyStage2,perschool(allcosts)£3,526forthenursery/receptionprogramme

£10,747perschool(£14,273foraschoolwithanurseryorreception)

* CYPSP2012Recommendations“HowtomakeNorthernIrelandanEarlyInterventionRegion”**Willneedtobeadjustedeachyearforinflation

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DoodleDen 5/6yearolds £18,000sitecostsplus£4,200pergroupof15children

£35,000todeliverinfourprimaryschools(15pupilseach)

TimetoRead 6-8yearolds Free.Thecriticalresourcearethevolunteerstodelivertheprogramme

Free

TotalCosts(assumingschool-basedprogrammesaredeliveredinfourschools/venues):£1,312,777

5.6CostsoftheCo-ordinationInfrastructureInadditiontoprogrammerelatedcosts,EarlyInterventionLisburnwouldrequirefundingforitsinfrastructure,inordertodevelopandimplementprogrammes;ensureprogrammefidelity/quality;co-ordinaterelationshipswiththevariousstakeholders;managefinance;ensureeffectivecommunityengagement,etc..

Cost Headings Annual Cost (need to adjust for inflation)

EarlyInterventionCommunityCo-ordinator(salary&relatedcosts)-Resurgam £35,000

EarlyInterventionDeliveryManager(salary&relatedcosts)–DeliveryPartner £45,000

EarlyInterventionQuality&MonitoringOfficer(salary&relatedcosts)–DeliveryPartner

£35,000

AdministrationandservicingoftheEarlyInterventionConsortium-Resurgam £3,000

Programme-relatedFinance/Administration £15,000

Travel(local,nationalandinternational),phonecosts £8,000

Officeandenergycosts-Resurgam £7,500

Officeandenergycosts–Deliverypartner £7,500

Stationary,PRandmarketingcosts(incNewsletter) £6,000

Governancecosts-Resurgam £3,000

Evaluation(seebelow) £50,000

CommunityConsultations-Resurgam £2,000

OneProject-TwoCitieswithEarlyInterventionDerry-LondonderryandeffectivepartnershipworkingwithotherEarlyInterventionsites

£10,000

Thecostofparent-friendlyeventsandactivitiestohelpbuildtherelationshipswithparentsandattractthemtoparticipateinmorerigorousprogrammes

£3,000

TotalAnnualCosts £230,000

Thetotalannualcostofimplementingtherecommendedprogrammesandtherelatedinfrastructurecostswouldthereforebec.£1,540,000.However,itislikelytobeseveralyearsbeforetheinvestmentcanbeputinplacetodeliveralltherecommendedprogrammes,sothefundingrequiredinyear1islikelytobeconsiderablylower.

ThecostsofSureStarthavenotbeenincludedinthesecalculations,astheyaresubjecttoseparatenegotiationswiththeEasternChildcarePartnership.

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Therearealsopotentialissuesconcerningcommunitypremiseswhereprogrammesaregoingtobedeleivered,whicharehardtocalculateatthisstage.Insomeofthetargetareastherearegoodcommunitybuildings;otherareasarelikelytobeabletoaccessgreatlyimprovedcommunitypremisesinthenearfuture.Therearealsosomeareaswithverypoorfacilities,whichcurrentlyprovidelittlescopeforadditionalearlyinterventionservices.

5.7EvaluationThereisanimportantissueconcerningtheevaluation(s)ofanyagreedprogrammesimplemented.Iftheprogrammeshavealreadybeenrobustlyevaluatedatleasttwice(as“proven”Blueprintsprogrammesare,oriftheyarealreadysubjecttoamajorRCTtrialelsewhereintheUKorIreland,itmaynotbenecessarytocommissionanRCTevaluation.However,programmesthathavesomepromisingevidence,suchasMellowParents,theParentInfantProgramme(PIP)andtheNewParentingProgramme,buthavenotyetbeensubjecttoalarge-scaleRCTshouldbesubjecttoaRCTtrial.Inadditionitisstillimportanttocommissionanobjectiveformativeandsummativeassessmentofhowwelltheprogrammeshavebeenimplemented,whatprogressisbeingmadeinachievingtheagreedoutcomes,andidentifyanylessonsthatcanbelearnt.

Itwouldalsobeincrediblyvaluabletocommissionalong-termassessment,againstdatafromcomparableareas,astotheextentthattheagreedsetofEarlyInterventionLisburnprogrammesoverallhavebeenabletoimpactonthemeasurableoutcomeindicators.Ideallythisshouldbeoveratleast15years.

Therearealsovariousexistingprogrammesandservicesforchildren,youngpeopleandfamiliescurrentlybeingdeliveredinsomeofthetargetareas.Theevidencefromthisreportwouldsuggestthatcollectivelytheseprogrammesandservicesarenotenablingthechildrenandyoungpeoplefromthetargetareastoachievetheirpotential.However,perhapstheseoutcomeswouldbeevenworseiftheseprogrammesandservices,orsomeofthem,didnotexist.Theseprogrammesandservicesneedtobeeffectivelymappedandassessedagainsttheevidencefortheimpacttheyaremakingonthedesiredoutcomes,highlightedabove.Itwouldthenbepossibletomakeinformeddecisionsonwaysof:

■ clarifyingoutcomesofexistingprogrammesandservicesandevaluatingtheirimpactontheseoutcomes;

■ focusingexistingprogrammesandservicestoimprovethedesiredservices;■ expandingexistingprogrammesandservices;■ co-ordinatingthevariousprogrammesandservicesbetter;■ reducingorclosingexistingservices;and/or■ fillingthegapsidentified.

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5.8PerformanceManagementInadditiontoexternalevaluationthereneedstobeaneffectiveperformancemanagementandqualityassurancesystemthatensuresthatallprogrammesaredeliveredwithfidelity(assetdownbytheownersofthelicense)andinaccordancewiththeobjectivesandcommitmentsagreedwithfunders.Somelicensedprogrammeshaveverytightfidelityandqualityassurancerequirementse.g.PATHS,othersarelesstightlyspecifiede.g.IncredibleYears.ThedangerinthelatteristhatprogrammmesmaybeimplementedinawaythatfailstoachievetheoutcomeswhichRCTevaluationshaveshowntheycanachieve.AnyprogrammesimplementedthroughEILneedtobedemonstrateaveryhighstandardoffidelity.

Therealsoneedstoaneffectiveprocessforgathering,measuring,analyzingandreportingonrelevantdatafromeachprogramme.

ThisissueisdiscussedmoreundertheOperatingModelbelow.

5.9PotentialSourcesofFunding:Fromthescanofpublicpolicydocuments,thefollowingareGovernmentDepartmentsandagencieswhichhaverelevantpublicpolicyobjectivesinrelationtotheagreedoutcomesandshouldthereforebepotentialsourcesoffundingfortheEarlyInterventionLisburnprogrammes:

■ OFMdFM–SocialInvestmentFund■ DHSSPS■ Health&SocialCareBoard■ PublicHealthAgency■ SouthEasternHealth&SocialCareTrust■ Children&YoungPersonsStrategicPartnership■ DepartmentofEducation■ SouthEasternEducation&LibraryBoard–schoolsbudget■ SouthEasternEducation&LibraryBoard–youthservicebudget■ Schools’ExtendedSchoolsbudget■ DepartmentofJustice■ YouthJusticeAgency■ ProbationBoard■ PSNI■ DepartmentofSocialDevelopment■ Departmentalresearchbudgetsreevaluations■ LisburnCityCouncil■ NIHousingExecutive■ BigLottery–e.g.SupportingFamilies■ Charitabletrusts/foundations

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5.10 TheoryofChangeLinkagesAtheoryofchangehighlightsthelogicoftheapproachtobeadoptedi.e.betweeninputs,activities,outputsandoutcomes.ThefollowinghighlightstheoveralllogicofthesuggestedEarlyInterventionLisburnapproach:

TheoverarchingobjectiveofEarlyInterventionLisburnis:ToimprovetheoutcomesforchildrenandyoungpeopleindisadvantagesareasofLisburn

Thisistobeachievedby:Puttinginplaceandeffectivelyimplementingprovenuniversalandtargetedprogrammeswhichhavebeenshowntoimproveoutcomesforchildrenandyoungpeopleoverasustainedperiod.

Thisistobeachievedby:BeingclearabouttheoutcomeswherechildrenandyoungpeopleindisadvantagedcommunitiesinLisburnfallsignificantlyshortoftheNorthernIrelandaverage.AND

IdentifyingthoseprovenuniversalandtargetedprogrammeswhichhavebeenshowntoimprovethespecificagreedoutcomesforchildrenandyoungpeopleindisadvantagedcommunitiesAND

Eitherrobustlyevaluating,and/orstopdelivering,existingprogrammesthatdonotdemonstrateclearlytheirpositiveimpactontheagreedoutcomesAND

Gainingeffectivecommunity,politicalandstatutorycommitmenttoandsupportfortheimplementationofacomprehensivesustainedearlyinterventionprogrammeandtoworkingeffectivelytogetherAND

Gainingsufficientlong-termfundingtosupportasustainedearlyinterventionprogrammeAND

Implementingagreeevidence-basedprogrammeswithfidelityAND

AttractingandretainingtheparticipationofthetargetparentsandchildrenintheprogrammesimplementedAND

Effectivelyevaluatingtheprogrammesagainstagreedoutcomes

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5.11 LogicModelThefollowinglogicmodelarticulatesinmoredetailthepotentialrelationshipbetweeninputs,activities,outputs,intermediateandfinaloutcomesandhowtheycanbemeasured.

Inputs Activities Outputs Intermediate outcomes

Final outcomes

==> ==> ==> ==>

AnnualFinancialsupportof£1.5Mfromstat.sources:• Co-ordinator

&programmestaff

• Programmecosts

• Governance&m’mentcosts

• Evaluation• Acommitment

fromagenciestoworktogethertoachievetheoutcomes

• Engagementoftargetlocalcommunities

• Supportfrompoliticalreps

• Contributionfromschoolstopromoteeffectivedelivery&liaison

• ContributionfromeachpartnertoparticipateintheConsort-ium&deliveragreedprogrammes

• Contributionfromparents&childrentoparticipate

• Qualityassurancere.programmefidelity

• Evaluationexpertise

UniversalinPrimarySchools

• PATHS(4-6yearolds)

• SuccessforAllinc.curiositycorner(age3-11)

• TimetoRead(8-10yrolds)

• LifeSkillsTraining(9-15yearolds)

UniversalinPost-PrimarySchools• LifeSkills

Training(9-15yearolds)

Targetedincommunityvenues• Incredible

Years(age0-12)

• BigBrothers/BigSisters(BB/BS)(6-18yearolds)

Targetedhome-based• FamilyNurse

P’ship(NFP)(pregnancy-2)

• MultisystemicTherapy(12-17yearolds

• PATHS(xsessionsforychildrenoverzmonths)

• SuccessforAll(xsessionsforychildrenoverzmonths)

• LifeSkillsTraining(xsessionsforychildrenoverzmonths)

• IncredibleYears(xsessionsforychildrenoverzmonths)in

• BB/BS(xsessionsforychildrenoverzmonths)

• FNP(xsessionsforychildrenoverzmonths)

• MultisystemicTherapy(xsessionsforychildrenoverzmonths)

• Reducednumberofteenagepregnancies

• Reducedlevelofsmokingduringpregnancy

• Improvedparentingskillsandconfidence

• Improvedparent-childattachmentfor0-2yearolds

• Improvedschoolattendance

• Improvedschoolreadinessamongst3&4yearolds

• Improvedthesocialandemotionalskillsandresilienceof4-11yearolds

• Improvedliteracy&numeracyinchildrenaged4-11

• Improvededucationalattainment

• Reducedbehavioural/conductproblems

• Reducedsmoking,alcohol&drugconsumptionamongstyoungpeople

• Reducedcrimeandanti-socialbehaviouramongstyoungpeople

• Improvedphysicalandmentalhealthofchildren

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How inputs will be measured

How activities will be measured

How outputs will be measured

How intermediate outcomes will be measured

How final outcomes will be measured

==> ==> ==> ==>

Financialbudgetandquarterlymanagementaccounts

Outputsinrelationtoparentandchildparticipation

ParticipationintheearlyYearsLisburnSteeringGroupandsub-groups

Outputs(seecolumntotheright)

Fidelitytotheprogrammemanual

Parentsatisfaction

Youngparticipantsatisfaction

Numberofprogrammesessionsdelivered

Numberofchildrenandyoungpeopleinvolvedintheprogrammes

Numberofparentsinvolvedintheprogrammes

%attendanceatprogrammes

%ofparticipantscompletingtheprogrammes

• %ofmotherssmokingduringpregnancy

• Increasedparentingconfidence(ParentsSenseofCompetenceScale)

• Increasedparentalengagementwiththeirchild’seducation

• Improvedchildbehaviour(TheEybergChildBehaviourInventoryforParentsandtheSutter-EybergBehaviourInventoryforteachers)

• Improvedchildsocial&emotionalskills(SDQforparentsandteachers)

• Literacy&numeracyatKeystages1&2

• Numberofteenagepregnancies

• Improvedparent-childattachmentfor0-2yearolds

• increased%ofchildrenwith85%schoolattendance

%deathsundertheageof75

Averageageatdeath

%youngpeoplegoingontohigherorfurthereducation

%ofyoungpeopleachieving5+GCSEsA*-C

%ofyoungpeopleachieving2+AlevelsA*-C

Numberofcrimesandanti-socialbehaviourincidents

Levelofsmoking,alcoholanddrugconsumptionamongstteenagers

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CHAPTER SIX

Operating model

6.1IntroductionItisvitaltohaveaneffectiveandacceptedoperatingmodeltoplanandimplementacomprehensiveprogrammeofuniversalandtargetedearlyinterventionprogrammesinLisburn.Thestructuresneedtoengageallthekeyagenciesifitistoensureeffectiveco-ordinationandseamlessdeliveryofservices.ItisalsovitallyimportantthatthelocalcommunitieswhichEarlyInterventionLisburnwouldservefeelasenseofownershipoftheprogrammesthataredelivered,otherwise,iftheyareperceivedtobeparachutedinbyexternalagencies,theprogrammesareunlikelytogettheparticipationofthosewhomostneedtheservicesinordertobesuccessful.

6.2ResurgamTrustTheResurgamDevelopmentTrusthasbeenestablishedtocreateacommunity-ownedorganisationdesignedtopromotetheinterestsofthoseindisadvantagedcommunitiesinLisburn.ItwasformallyconstitutedasacompanylimitedbyguaranteeinJanuary2011.IthasbeenacceptedascharitablefortaxpurposesbytheInlandRevenue.ThemembershipofResurgamismadeupofc.1,000individualmembers(adultsandyoungpeople).TheBoardismadeupofrepresentativesfromlocalcommunityandyouthorganisations.

ItisResurgamthatinitiatedthecurrentexplorationofanearlyinterventionapproachtoaddressingmanyoftheproblemsfacedbydisadvantagedcommunitiesinLisburnandcurrentlyco-chairsandservicestheEarlyInterventionLisburnSteeringGroupmadeupofawiderangeofrelevantagencies.

Currently,atthetimeofwritingthisreport,however,Resurgamisaverynewplayeranddoesnotreceiveanycorefunding.ThisisanissuethatwouldneedtoberesolvedifitistohavethecapacitytoplayaleadingroleinthedevelopmentandmanagementofEarlyInterventionLisburn.DiscussionsarecurrentlytakingplacewithDSDinrelationtoResurgamasaflagshipsocialenterpriseinitiative.

ItisalsoimportantthatResurgamhastheorganisationalandfinancialpoliciesandprocedures,andassuredgovernancedevelopmentprocessesthatreflectitspotentialasthecentralco-ordinatingandservicingbodyofEarlyInterventionLisburn.

6.3ChildrenandYoungPeople’sOutcomesGroupAsecondkeyplayeristheinter-agencyinter-sectoralSouthEasternOutcomesGroupoftheChildrenandYoungPeople’sStrategicPartnership,whichisplayingavitalroleindrivingtheearlyinterventionagenda.AllthemainstatutoryandvoluntarybodiesconcernedwithmeetingtheneedsofchildrenandyoungpeoplewithintheSouth-Easternareaarerepresentedonthegroup.

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TheEarlyInterventionLisburnSteeringGroup,whichhasrepresentativesfromvariouscommunitygroupsandallthekeystatutoryagencies,shouldberefreshedastheEarlyInterventionLisburnConsortiumandberecognisedasaLocalitysub-groupoftheSouth-EasternYoungPeople’sStrategicPartnershipOutcomesGroupandshouldbecomethekeyco-ordinatinginter-agencybody,similartotherolefulfilledbyHealthImprovementorHealthCitiesPartnerships.

6.4OtherImportantPartnersThefollowingaresomeoftheotherkeyplayerswhichneedtobeengagedandcommittedtotheEarlyInterventionLisburnConsortiumifitistobeasuccess:

■ PublicHealthAgency■ SouthEasternHealth&SocialCareTrust■ SouthEasternChildcarePartnership■ DepartmentofEducation■ SouthEasternEducation&LibraryBoard/ESA■ StatutoryYouthService-SouthEasternEducation&LibraryBoard/ESA■ DepartmentofJustice/YouthJusticeAgency■ PSNI■ DepartmentofSocialDevelopment■ LisburnCityCouncil■ NIHousingExecutive■ Electedrepresentatives

6.5DeliveryPartner(s)Deliveringtheportfolioofearlyinterventionprogrammesrecommendedinthisreportwillrequireextensiveexperienceofdeliveringandqualityassuringprogrammesforchildrenandfamilies.ItisthereforevitalthatoneofmoreexperienceddeliverypartnerareappointedbyEarlyInterventionConsortiumLisburnConsortium.

Thereisanimportantquestionastohowmanydeliverypartnersthereshouldbe.Itispossibletomakeanargumentforseveraldifferentarrangements:

Option 1: Separatedeliverypartnersforeveryprogramme(potentiallylargenumberofdifferentdeliverypartners)■ Pros:abletobringinexperienceofdeliveringallthetargetprogrammes;bodies

currentlydeliveringthetargetprogrammeselsewherecanbeincludedinEIL■ Cons:complexstructure;variousdifferentorganisationalculturesand

systems;complex,diffuseaccountability;moredifficulttobuildeffectiverelationshipsandcross-programmeworking;timeandenergyrequiredtoeffectivelyco-ordinatethevariousbodies

CHAPTER SIX

Operating model

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Option2:Oneexperienceddeliverypartnerwhichtakesresponsibilityfortheimplementationofallprogrammes■ Pros:simplestructure;singleorganisationalcultureandsystems;clear

accountability;easiertobuildeffectiverelationshipsandcross-programmeworking

■ Cons:onebodyisunlikelytohavepreviousexperienceofdeliveringallthetargetprogrammes.

Option 3: Onedeliverypartner,whichcansub-contractdeliveryofprogrammes,ifnecessary■ Pros:Simplestructure;singleorganisationalcultureandsystem;clear

accountabilityandreportinglines;easytobuildeffectiverelationships;canengageotheragenciesindelivery(e.g.SEHSCTindeliveringFNP);sub-contractingcanbequalityassuredbythedeliverypartner;strongeffectiveco-ordinationbetweentheprogrammes

■ Cons:SuccessoftheEILinitiativedependsontheappointmentoftherightdeliverypartnerwhichcandelivercomplexprogrammeswithfidelityandworkwellwiththecommunity

Option3isrecommended.

6.6PotentialroleofResurgamCommunityengagementiscriticaltothesuccessofEarlyInterventionLisburn.Resurgam,asanrepresentativeumbrellacommunitybodyforthetargetareas,has,therefore,acrucialroleinthesuccessoftheinitiative.TheSouth-EasternYoungPeople’sStrategicPartnershipOutcomesGroup,onbehalfoftherelevantagencies,shouldcontractwithResurgumtofulfillthefollowingrolesfortheEarlyInterventionLisburnConsortium/LocalityGroup:

Consortium■ Organiseandco-ordinatemeetingsoftheEarlyInterventionLisburn

Consortium(notlessthan4/5timesayear)■ EnsureallConsortiummeetingsarewellplannedandeffectivelyserviced■ Provideaco-chairfortheConsortium■ EnsuretheEarlyInterventionLisburnConsortiumhastheappropriate

structureandofficers■ EnsuretheConsortiumoperatestothehighestgovernancestandardsand

regularlyreviewsitsperformance

DeliveryPartner■ Drawupthebrief(withexpertassistanceifrequired)fortheappointmentofa

deliverypartner,forapprovalbytheConsortium

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■ ServicetherecruitmentandselectionofadeliverypartnerbyapanelappointedbytheEILConsortium

■ Maintaineffectiveliaisonwiththedeliverypartner■ Facilitateandsupporttherelationshipbetweenthedeliverypartnerand

relevantcommunitygroups/organisations■ LiaisewiththeDeliveryPartnerinrelationtothedevelopmentoftheportfolio

ofnewevidence-basedearlyinterventionprogrammes,asagreedwiththeConsortium

RiskManagement■ Develop,andkeepup-to-date,ariskregister■ HighlighttotheConsortiumandDeliveryPartneranypotentialbarriersor

challengestoachievingtheagreedplans■ EnsureResurgamandEarlyInterventionInitiativeLisburnConsortium

complywiththehigheststandardsinrelationtogovernanceandpotentialconflictsofinterest

MarketingandPR■ ActivelypromoteandpublicisetheEarlyYearsLisburnInitiative,locallyinthe

targetcommunitiesandwidercommunitynetworks■ Activelysupportthemarketingofrelevantprogrammesinthetargetareas■ ProducearegularEarlyInterventionLisburnNewsletter,inpartnershipwith

theDeliveryPartner,anddisseminatewidelywithinthetargetcommunities

Employment■ EmployandmanageanEarlyInterventionCommunityEngagementOfficer■ Ensuregoodpracticeintherecruitment,selection,inductionandmanagement

ofstaffinallaspectsofEarlyInterventionLisburn■ Contributeasapanelmembertotheselectionofstaffforagreedprogrammes

ProgrammeDevelopment■ Negotiate,withtheConsortium,fundingfortheinitialagreedevidence-based

programmesandinfrastructurecosts■ Facilitate(withexpertassistanceifnecessary)thedevelopment,

implementationandmonitoringofoverallEarlyInterventionLisburnstrategicandannualoperationalplans

QualityAssurance&PerformanceManagement■ ConsiderQualityassurancereportsfromtheDeliveryPartnerinrelationto

ensuringtheeffectivedeliveryoftheoverallprogrammeandensuringthefidelityofevidence-basedprogrammes

CHAPTER SIX

Operating model

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■ EnsuretheDeliveryPartnerhasappropriatesystemsinplacetomonitorandevaluatetheperformanceofagreedprogrammes;andagainstspecificindicatorsfortheoverallprogrammeinrelationtoeachOutcome

Finance■ Ensurethehigheststandardsoffinancialplanning,accountingandreporting■ Ensureappropriatefinancialreportingmechanismstofunders/contractors

whichareprovidingfundingdirectlytoResurgamand/ortheEarlyInterventionLisburnConsortium

Collaboration■ Collaborateeffectivelywithothercommunityorganisationsengagedinearly

interventioninitiativesinNorthernIreland,GBandIreland■ Buildeffectiverelationshipsandworkpositivelytoresolveanydisputesor

difficulties

Consultation■ Activelypromotetheactiveparticipationofallthelocaltargetcommunitiesin

theagreedprogrammes■ Consultlocaltargetcommunitiesonperceptionsoftheprogrammesand

emergingneedsandissues■ EnsurethereisaneffectivecommunityvoiceontheEarlyInterventionLisburn

Consortium■ Ensureallrelevantlocalcommunitygroupsareeffectivelyrepresentedon

Resurgam

ResearchandEvaluation■ FacilitatetheappointmentandservicingofanExpertAdvisoryCommittee(of

earlyinterventionandevaluationexperts)toadvisetheConsortium■ Drawupabrief(withexpertassistance,ifrequired)fortheappointmentof

evaluators■ Sourceexperiencedevaluatorsthroughadministeringathoroughtender

recruitmentprocessandsitonthepanel(thepaneltobeappointedbyEILConsortium)

■ Ensuretheevaluationcontractiseffectivelymanaged■ Ensureeffectiveliaisonwithevaluators

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6.7RoleoftheDeliveryPartnerThefollowingissuggestedasappropriateresponsibilitiesoftheDeliveryPartner:

QualityAssurance&PerformanceManagement■ Ensuretheagreedprogrammesaredeliveredwithfidelity,througheffective

qualityassurance■ Ensuregoodpracticeinidentifyingandsourcinganysub-contracteddelivery

bodies■ Ensurethereareappropriatesystemsinplacetointernallymonitorand

evaluatetheperformanceofagreedprogrammes

ProgrammeDevelopment■ Contributetothenegotiationsforfundingofagreedevidence-based

programmesandinfrastructurecosts■ Developtenderbriefsforagreedprogrammestobedeliveredbysub-

contractors,forConsortiumapproval■ Contributetothedevelopment,implementationandmonitoringofoverall

EarlyInterventionLisburnstrategicandannualoperationalplans■ LiaisewiththeEarlyInterventionLisburnConsortiumandResurgamin

relationtothedevelopmentoftheportfolioofnewevidence-basedearlyinterventionprogrammes

RiskManagement■ Develop,andkeepup-to-date,ariskregisterinrelationtotheagreed

programmes■ HighlighttotheConsortiumandResurgam,assoonaspossible,anybarriers

orchallengestoachievingtheagreedplans■ Complywiththehigheststandardsinrelationtogovernanceandpotential

conflictsofinterest

MarketingandPR■ ActivelypromoteandpublicisetheEarlyYearsLisburnInitiative,locallyinthe

targetcommunities,NI-wideandintheUKandIreland■ Activelymarkettherelevantprogrammesinthetargetareas■ ProducearegularEarlyInterventionLisburnNewsletter,inpartnershipwith

Resurgam

Employment■ EmployandmanageanEarlyInterventionManager(notnecessarilythefinal

jobtitle)toleadandco-ordinatethevariousprogrammesandliaisewiththeConsortiumandResurgam

CHAPTER SIX

Operating model

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■ Ensuregoodpracticeintherecruitment,selection,inductionandmanagementofstaffinallaspectsofEarlyInterventionLisburn

■ Contributetotheselectionofstaffforanyagreedsub-contractedprogrammes■ Ensureallstaffaretrainedtotheappropriatestandard

Finance■ Ensurethehigheststandardsoffinancialplanning,accountingandreporting■ Ensureappropriatefinancialreportingmechanismstofunders/contractors

Collaboration■ EnsureeffectivecollaborationwithSureStart,relevantschools,andother

relevantprogrammes,organisationsandvenues■ Collaborateeffectivelywithotherearlyinterventiondeliverybodiesin

NorthernIrelandandbuildrelationshipswithotherearlyinterventioninitiativesinGBandIreland

■ Liaisecloselywithanysub-contracteddeliveryagenciesandworkpositivelytoresolveanydisputesordifficulties

Consultation■ Activelypromotetheactiveparticipationofthelocaltargetcommunities■ Consultlocaltargetcommunitiesonperceptionsoftheprogrammesand

emergingneedsandissues

ResearchandEvaluation■ KeepuptodatewithemergingevidenceintheUK,Irelandandinternationally

oftheefficacyofrelevantearlyinterventionprogrammes■ Ensurethereisanappropriateperformancemanagementinformationsystem

whichiseffectivelyimplemented■ Ensuretheevaluationcontractiseffectivelymanaged■ Ensureeffectiveliaisonwithevaluators

Reporting■ ProduceareportfortheEarlyInterventionLisburnConsortiumandResurgam

(notlessthan4timesayear)inaformatagreedwiththeConsortium■ Producefinancialandmonitoringreportsasagreedwiththerelevantfunders

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CHAPTER SEVEN

Implementation plan

7.1IntroductionThisshortsectionwilloutlinethenextstepsintermsofmovingtowardsimplementingtherecommendationsabove.Itisnotpossibletoimplementarangeofnewprogrammesatonce,soitisimportanttophasetheirintroduction.Whichprogrammeswouldbeimplementedbeforeotherprogrammeswouldbepartlydeterminedbyfunding,theavailabilityofaDeliveryPartnerwithrelevantexperience,andthereadinessoftheenvironmente.g.thecommunitiesandschoolstosupporttheimplementationofaprogramme.

7.2TimetableThefollowingoutlinesasuggestedimplementationplanbetweenJune2012andDecember2018:

June–September2012■ EarlyInterventionLisburnSteeringGrouptodiscussthereportandagree

whichrecommendations(ifany)itwishestoendorse

■ Agreetheprocessforprintinganddisseminatingthereport

■ MeetwiththeSouthEastOutcomesGroupoftheChildren&YoungPerson’sStrategicPartnershiptodiscussthereport

■ Agreeaprogrammeofface-to-facepresentationsofasummaryofthereporttoarangeofkeystakeholders,includingcommunityorganisationsandstatutoryagencies

■ Agreetheprocessfordevelopingacommonoutcomesframework(whichwillenableimpacttobemeasured)andasharedfocusonqualityachievedthroughjointreflectivepractice,trainingandpeerlearning,wherebydifferentorganisationscanlearnfromoneanother.

■ BringexistingorganisationstogethertoidentifyhowbesttotransformtheculturewithintheCityofLisburn,especiallywithinareasofdeprivation,toemphasiseaspirationandachievement(particularlyinrelationtoeducation)throughlocalmedia,doortodoorconsultations,celebratinglocalchampionsetc.

■ Agreeaprocessformappingexistingservices/programmesservingdisadvantagedcommunitiesinLisburnandtheevidenceforthecontributiontheymaketowardstheagreedoutcomes

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■ MeetwiththeprimaryschoolsintheExtendedSchoolsprogrammeinLisburntodiscusswiththemthekindsofsupportandassistancetheyrequiretohelpthemachievetheirobjectivesandthepotentialtohostappropriateprovenmodelsintheschools

■ DrawupabriefandprocessfortheappointmentofaDeliveryPartner.

■ AppointanappropriateDeliveryPartner

■ AgreeaService-LevelAgreementwiththeDeliveryPartner

■ Considerthepotentialforanyoftheprogrammestobedeliveredinpartnershipoverawidergeographicalarea(e.g.theOneProject:TwoCitiesinitiative;SEHSCTarea)

■ Identifythemostappropriatesource(s)ofinfrastructurefinance,andapply,forfundinginaccordancewithappropriateobjectivesandprocedures.

■ Identifythepotentialfundersofrecommendedprogrammesandarrangemeetingswitheachtodiscussthereportandpotentialfunding

■ NegotiateaninitialcontractbetweentheChildren&YoungPerson’sStrategicPartnershipandResurgamtotakeforwardtherecommendationsinthereport

■ DrawupandapprovejobdescriptionsandspecificationsforinfrastructurepostsinResurgamandtheDeliveryPartner

■ ArrangestudyvisitstoseetherecommendedprogrammesintheUKandIrelandinoperation

■ EnsureResurgamhasalltheorganisationalpoliciesandprocedures,financialpoliciesandprocedures,andexternallysupportedgovernancedevelopmentprocessesthatreflectitspotentialastheco-ordinatingandservicingbodyoftheEarlyInterventionLisburnConsortium

■ ConsiderthemostappropriatemembershipoftheEarlyInterventionConsortium

■ Appointtheco-chairsoftheearlyInterventionLisburnConsortium

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October–December2012■ RecruitandselectaResurgamEarlyInterventionCommunityCo-ordinator

(subjecttofundinghavingbeennegotiated)throughopenrecruitment(inaccordancewithagreedpoliciesandprocedures)

■ TheDeliveryPartnertorecruitandselectanappropriateEarlyInterventionLisburnDeliveryManager

■ Drawup(DeliveryPartner)servicedesignbriefsforeachoftheagreedphase1programmese.g.fromIncredibleYears,FamilyNursePartnerships,BigBrother/BigSisters,PATHS,SuccessforAllandLifeSkillsTraining

■ Putdetailedproposals/applicationstofunders/contractors,inrelationtophase1programmesandinfrastructure,asagreed

■ Meetwiththetargetschoolsconcerningtheirpotentialtohostappropriateprogrammese.g.Incredibleyearsfullparentandchildprogrammes,PATHSandSuccessforAll

■ DrawupanevaluationbrieffortheoverallEarlyInterventionLisburnProgrammeandseekfundingfortheevaluation

January–March2013■ InductandtraintheResurgamEarlyInterventionCommunityCo-ordinator

andDeliveryPartnerEarlyInterventionDeliveryManager

■ RecruitandselectaDeliveryPartnerEarlyInterventionQuality&MonitoringOfficer(subjecttofundinghavingbeennegotiated)throughopenrecruitment(inaccordancewithagreedpoliciesandprocedures)

■ Goouttotenderonthephase1agreedprogrammese.g.fromIncredibleYears,FamilyNursePartnershipsandBigBrothers/BigSisters,PATHS,SuccessforAll,LifeSkillsTraining,whenappropriatefundinghasbeenapproved

■ MeetwithBITCaboutthepotentialtodeliverTimetoReadintheadditionaltargetprimaryschools

■ Putmoredetailedproposals/applicationtofunders/contractors,inrelationtophase1asagreed

■ Agreewhichprogrammestoincludeinphase2e.g.fromthepriorityprogrammesnotimplementedinphase1

CHAPTER SEVEN

Implementation plan

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■ Goouttotenderforanappropriateevaluationteam

■ Drawupandagreeastrategicplanfor2013-2018andanoperationalplanfor2013/14.

April2013–August2013■ DeliveryPartnertocarryoutthestartup(planning,trainingandrecruitment)

phaseofthefirstearlyinterventionprogrammes

■ Marketthephase1programmeseffectivelytothetargetlocalaudiences

■ Drawupservicedesignbriefsandtenderspecificationsforeachoftheagreedphase2programmes

■ Evaluatorstoagreemeasuresandinstrumentsandcarryoutbaselinemeasurement

■ Putdetailedproposals/applicationtofunders/contractors,inrelationtophase2asagreed

■ EarlyInterventionLisburnConsortiumandResurgamtodiscussannualearlyinterventionreportfromtheDeliveryPartner

September–December2013■ Startdeliveringagreedphase1earlyinterventionprogrammes

■ Evaluatorstoproducebaselinereport

■ Putmoredetailedproposals/applicationtofunders/contractors,inrelationtophase2programmes,asagreed

■ Goouttotenderonthephase2agreedprogrammes,whenappropriatefundinghasbeenapproved

January-June2014■ DeliveryPartnertocarryoutstartupphase(planning,negotiatinglicenses,

training,baselineevaluationandrecruitment)ofphase2earlyinterventionprogrammes

■ Agreewhichprogrammesshouldbepartofphase3

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■ Putdetailedproposals/applicationtofunders/contractors,inrelationtophase3programmes,asagreed

■ EarlyInterventionConsortiumandResurgamtodiscussannualearlyinterventionreportfromtheDeliveryPartner

July–December2014■ Startdeliveringagreedphase2earlyinterventionprogrammes(community,

homeandschoolbased)

■ Drawupservicedesignbriefsandtenderspecificationsforeachoftheagreedphase3programmes

■ Goouttotenderonthephase3agreedprogrammes

■ ReviewthegovernanceoftheEarlyInterventionLisburninitiativeandagreeactionstofurtherimproveit

■ Putmoredetailedproposals/applicationtofunders/contractors,inrelationtophase3programmes,asagreed

■ Consider1styearformativeevaluationreport(s)andadjustmentsrequiredinthedeliveryoftheprogrammes

January–June2015■ Startup(planning,negotiatinglicenses,training,baselineevaluationand

recruitment)phaseofphase3earlyinterventionprogrammes

■ Agreewhichprogrammesshouldbepartofphase4(considerableadditionalevidenceonwhatworksintermsofearlyinterventionshouldbeavailableatthispoint,incarangeofRCTsinIrelandandGB)

■ Putdetailedproposals/applicationtofunders/contractors,inrelationtophase4programmes,asagreed

■ EarlyInterventionsteeringgrouptodiscussannualearlyinterventionreportfromResurgam

CHAPTER SEVEN

Implementation plan

Page 107

July–December2015■ Startdeliveringagreedphase3earlyinterventionprogrammes

■ Considertheformative2yearevaluationreport(2yearsofphase1and2yearsofphase2)

■ Drawupservicedesignbriefsforeachoftheagreedphase4programmes(wherefundingisagreedandthereisaviabledeliveryagency),whichhavenotbeendevelopedintheprevious3phasesoftheprogramme.

January–June2016■ Startup(planning,negotiatinglicenses,training,baselineevaluationand

recruitment)phaseofphase4earlyinterventionprogrammes

■ EarlyInterventionsteeringgrouptodiscussannualearlyinterventionreportfromResurgam

July–December2016■ Startdeliveringagreedphase4earlyinterventionprogrammes

■ Considerthe3yearevaluationreport(3yearsofphase1;2yearsofphase2;and1yearofphase3)

■ ReviewthegovernanceoftheEarlyInterventionLisburninitiativeandagreeactionstofurtherimprovethem

January–June2018■ EarlyInterventionConsortiumandResurgamtodiscussannualearly

interventionreportfromtheDeliveryPartner

July–December2017■ Considerthe4yearevaluationreport(4yearsofphase1;3yearsofphase2;2

yearsofphase3;and1yearofphase4)

January–June2018■ EarlyInterventionConsortiumandResurgamtodiscussannualearly

interventionreportfromtheDeliveryPartner

July–December2018■ Considerthe5yearevaluationreport(5yearsofphase1;4yearsofphase2;3

yearsofphase3;and2yearsofphase4)

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PrioritiestoinformtheActionPlanfortheSouthEasternAreaConsultationDocumentJanuary2012SouthEasternOutcomesGroupCYPSP

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APPENDIX ONE

Terms of Reference for the developmentof a detailed model of delivery for Early Intervention Lisburn

BackgroundResurgumDevelopmentTrusthasdevelopedtheconceptofanEarlyInterventionLocalitywithinLisburninordertomeetarangeofdisproportionatelypooroutcomesforchildrenandfamiliesintheLisburnarea.Todevelopthisconceptfurther,ResurgumandthePublicHealthAgencyhavecommissionedBarnadostodeliverspecificdeliverableswhichwillhelptakethisinitaiveforward.Barnadosarealsocontributingfundingtothisprojectinaspiritofcollaborationandhaveallocatedanexperiencedconsultanttooperationallyleadthisworkontheirbehalf.

TimescaleAlldeliverablesshouldbecompletedby31stMay,2012

DeliverablesThemaindeliverablefromthispieceofworkwillbeasinglereporttitled‘TheDevelopmentofanEarlyInterventionLocalitywithinLisburn’.Withinthisreport,severaldistinctelementswillbecovered,asdetailedbelow:

1. TheCaseforChange:thissectionwillarticulatewhyanearlyinterventioninitiativeisrequiredinLisburn.ItwoulddetailoutcomesforchildrenlivingwithinthemostdeprivedestateswithinLisburn,especiallyOldWarren,HillhallandTonagh(althoughitwillalsocoverotherestates)andhowthesecomparewithotherareasinNorthernIreland.ThissectionwillalsodetailthespecificneedswithinLisburn,thecurrentservicesinplace,thegapsandthepotentialoverlapsbetweencurrentservices.

2. SharedOutcomesandPrinciples:ThiskeysectionwillarticulatethesharedOUTCOMESandPRINCIPLESthatallstakeholdersinEarlyInterventionLisburnhavesignedupto.Obviously,togettothispoint,engagementwithcommunity,statutory(includingschools)andvoluntarypartnerswillneedtotakeplace.Thisengagementshouldincludeallkeystakeholdersandshouldbefullyinclusivefromanearlystage.TheengagementprocesswillneedtobedesignedandimplementedtoensuretheviewsofallkeystakeholdersareincludedandthatagreementisreachedbetweenallpartnersastowhichsharedoutcomesandprinciplesshouldunderpinthedevelopmentofEarlyInterventionLisburn.

3. Whatworks–aglobalreviewofevidence:UsingtheOutcomesagreedinsection2,thissectionwilldetailthetypesofprogrammesandpracticeswhichhavebeenproventodelivertheexpectedOutcomese.g.improvedadolescentmentalhealth,reducedteenagedrinking,kidsmorereadyforschoolinP.1,improvedschoolattendanceorbetteracademicachievementetcetc.

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4. DesignofanintegratedmodelofdeliveryforEarlyInterventionLisburn(EIL):ThiselementwilltakeallthelearningfromtheprevioussectionsandwilldesignasuiteofinterventionswhichcollectivelywillenableEILtoachievetheOutcomesidentifiedinsection2.Thus,eachinterventionwillbeclearlylinkedtospecificOutcomes.Inaddition,clearperformanceindicatorswillbeidentifiedtoensurethatprogresstowardsspecificoutcomescanbemeasurede.g.GCSEresultsforanoutcomeofbetteracademicachievement.Thissectionwillalsoprovideanestimatefortheoverallprojectedcostoftheprogramme.ThiscostshouldincludetherecruitmentbyResurgumofanoverallEILProgrammeManagertooverseetheimplementationoftheEILinitiative.Thissectionwillnotdetailpotentialprovidersbutmayprovideexamplesofwherespecificprogrammeshavebeenproventomakeameasurabledifferenceinotherareas.

5. RoleofResurgumasprogrammeowners:ThissectionwillprovidebackgroundinformationaboutResurgumandwilllayouttherationaleforResurgumtakingresponsibility,asaleadingcommunityorganisationinLisburn,forthedeliveryoftheEarlyInterventionLisburninitiative.SpecificelementsoftheroleofResurgummayinclude:

a. Responsibilityforfinancialmanagementb. Responsibilityforidentifyingandsourcing,viatendering,thebest

providersforeachinterventionc. Monitoringtheperformanceagainstspecificindicatorsfortheoverall

programmeinrelationtoeachOutcomed. Reportingprogresstofunderse. Qualityassuranceofthedeliveryoftheoverallprogramme

6. ImplementationPlan:Thisshortsectionwilloutlinethenextstepsintermsofmovingtowardsimplementationsuchasdesigningadetailedspecificationforeachintervention,leadingtotenderdocumentationandtherecruitmentbyResurgumofanoverallEILProgrammeManager.

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APPENDIX TWO

Membership of the Early Intervention Lisburn Steering Group:

AdieBird(Chair)DenisPaisleyJasonWhiteAnneHardyMabelScullionCarolineMcGrathIanSutherlandJonathonCraigMartinDevlinNeilMcGivernMonicaMcCannPaulPorterUnaGeelanPaulGivanFrancisFerris

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APPENDIX THREE

Descriptions of Recommended Early Intervention Programmes

MultisystemicTherapy

BigBrothersBigSisters

FunctionalFamilyTherapy

LifeSkillsTraining

FamilyNursePartnerships

PATHS(PromotingAlternativeThinkingStrategies)

IncredibleYears

TripleP–PositiveParenting

Parent-ChildHome

ReadingRecovery

Parent-ChildInteractionTherapy

FathersReadingEveryDay(FRED)

TimetoRead

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MULTISYSTEMICTHERAPY(MST)

ProgramSummaryMultisystemicTherapy(MST)isanintensivefamily-andcommunity-basedtreatmentthataddressesthemultipledeterminantsofseriousantisocialbehaviorinjuvenileoffenders.Themultisystemicapproachviewsindividualsasbeingnestedwithinacomplexnetworkofinterconnectedsystemsthatencompassindividual,family,andextrafamilial(peer,school,neighborhood)factors.Interventionmaybenecessaryinanyoneoracombinationofthesesystems.

ProgramTargetsMSTtargetschronic,violent,orsubstanceabusingmaleorfemalejuvenileoffenders,ages12to17,athighriskofout-of-homeplacement,andtheoffenders’families.

ProgramContentMSTaddressesthemultiplefactorsknowntoberelatedtodelinquencyacrossthekeysettings,orsystems,withinwhichyouthareembedded.MSTstrivestopromotebehaviorchangeintheyouth’snaturalenvironment,usingthestrengthsofeachsystem(e.g.,family,peers,school,neighborhood,indigenoussupportnetwork)tofacilitatechange.

ThemajorgoalofMSTistoempowerparentswiththeskillsandresourcesneededtoindependentlyaddressthedifficultiesthatariseinraisingteenagersandtoempoweryouthtocopewithfamily,peer,school,andneighborhoodproblems.Withinacontextofsupportandskillbuilding,thetherapistplacesdevelopmentallyappropriatedemandsontheadolescentandfamilyforresponsiblebehavior.Interventionstrategiesareintegratedintoasocialecologicalcontextandincludestrategicfamilytherapy,structuralfamilytherapy,behavioralparenttraining,andcognitivebehaviortherapies.

MSTisprovidedusingahome-basedmodelofservicesdelivery.Thismodelhelpstoovercomebarrierstoserviceaccess,increasesfamilyretentionintreatment,allowsfortheprovisionofintensiveservices(i.e.,therapistshavelowcaseloads),andenhancesthemaintenanceoftreatmentgains.TheusualdurationofMSTtreatmentisapproximately60hoursofcontactoverfourmonths,butfrequencyanddurationofsessionsaredeterminedbyfamilyneed.

ProgramOutcomesEvaluationsofMSThavedemonstratedforseriousjuvenileoffenders:

■ reductionsof25-70%inlong-termratesofrearrest,

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■ reductionsof47-64%inout-of-homeplacements,■ extensiveimprovementsinfamilyfunctioning,and■ decreasedmentalhealthproblemsforseriousjuvenileoffenders.

ProgramCostsMSThasachievedfavorableoutcomesatcostsavingincomparisonwithusualmentalhealthandjuvenilejusticeservices,suchasincarcerationandresidentialtreatment.Atacostof$4,500peryouth,arecentpolicyreportconcludedthatMSTwasthemostcost-effectiveofawiderangeofinterventionprogramsaimedatseriousjuvenileoffenders.

ProgramBackgroundMultisystemicTherapy(MST)wasdevelopedinthelate1970s.Itaddressesseverallimitationsofexistingmentalhealthservicesforseriousjuvenileoffenderswhichincludeminimaleffectiveness,lowaccountabilityofserviceprovidersforoutcomes,andhighcost.

Treatmentefforts,ingeneral,havefailedtoaddressthecomplexityofyouthneeds,beingindividually-oriented,narrowlyfocused,anddeliveredinsettingsthatbearlittlerelationtotheproblemsbeingaddressed(e.g.,residentialtreatmentcenters,outpatientclinics).Givenoverwhelmingempiricalevidencethatseriousantisocialbehaviorisdeterminedbytheinterplayofindividual,family,peer,school,andneighborhoodfactors,itisnotsurprisingthattreatmentsofseriousantisocialbehaviorhavebeenlargelyineffective.Restrictiveout-of-homeplacements,suchasresidentialtreatment,psychiatrichospitalization,andincarceration,failtoaddresstheknowndeterminantsofseriousantisocialbehaviorandfailtoalterthenaturalecologytowhichtheyouthwilleventuallyreturn.Furthermore,mentalhealthandjuvenilejusticeauthoritieshavehadvirtuallynoaccountabilityforoutcome,asituationthatdoesnotenhanceperformance.Theineffectivenessofout-of-homeplacement,coupledwithextremelyhighcosts,haveledmanyyouthadvocatestosearchforviablealternatives.MSTisonetreatmentmodelthathasawell-documentedcapacitytoaddresstheaforementioneddifficultiesinprovidingeffectiveservicesforjuvenileoffenders.

TheoreticalRationale/ConceptualFrameworkConsistentwithsocial-ecologicalmodelsofbehaviorandfindingsfromcausalmodelingstudiesofdelinquencyanddruguse,MSTpositsthatyouthantisocialbehaviorismultideterminedandlinkedwithcharacteristicsoftheindividualyouthandhisorherfamily,peergroup,school,andcommunitycontexts.Assuch,MSTinterventionsaimtoattenuateriskfactorsbybuildingyouthandfamilystrengths(protectivefactors)onahighlyindividualizedandcomprehensivebasis.Theprovisionofhome-basedservicescircumventsbarrierstoserviceaccessthat

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oftencharacterizefamiliesofseriousjuvenileoffenders.Anemphasisonparentalempowermenttomodifythenaturalsocialnetworkoftheirchildrenfacilitatesthemaintenanceandgeneralizationoftreatmentgains.

BriefDescriptionofInterventionMSTisapragmaticandgoal-orientedtreatmentthatspecificallytargetsthosefactorsineachyouth’ssocialnetworkthatarecontributingtohisorherantisocialbehavior.Thus,MSTinterventionstypicallyaimto:■ improvecaregiverdisciplinepractices;■ enhancefamilyaffectiverelations;■ decreaseyouthassociationwithdeviantpeers;■ increaseyouthassociationwithprosocialpeers;■ improveyouthschoolorvocationalperformance;■ engageyouthinprosocialrecreationaloutlets;and■ developanindigenoussupportnetworkofextendedfamily,neighbors,and

friendstohelpcaregiversachieveandmaintainsuchchanges.

Specifictreatmenttechniquesusedtofacilitatethesegainsareintegratedfromthosetherapiesthathavethemostempiricalsupport,includingcognitivebehavioral,behavioral,andthepragmaticfamilytherapies.

MSTservicesaredeliveredinthenaturalenvironment(e.g.,home,school,andcommunity).Thetreatmentplanisdesignedincollaborationwithfamilymembersandis,therefore,familydrivenratherthantherapistdriven.TheultimategoalofMSTistoempowerfamiliestobuildanenvironment,throughthemobilizationofindigenouschild,family,andcommunityresources,thatpromoteshealth.Thetypicaldurationofhome-basedMSTservicesisapproximatelyfourmonths,withmultipletherapist-familycontactsoccurringeachweek,determinedbyfamilyneed.

AlthoughMSTisafamily-basedtreatmentmodelthathassimilaritieswithotherfamilytherapyapproaches,severalsubstantivedifferencesareevident:

1. MSTplacesconsiderableattentiononfactorsintheadolescentandfamily’ssocialnetworksthatarelinkedwithantisocialbehavior.Hence,forexample,MSTprioritiesincluderemovingoffendersfromdeviantpeergroups,enhancingschoolorvocationalperformance,anddevelopinganindigenoussupportnetworkforthefamilytomaintaintherapeuticgains.MSTprogramshaveanextremelystrongcommitmenttoremovingbarrierstoserviceaccess(e.g.,thehome-basedmodelofservicedelivery).

2. MSTservicesaremoreintensivethantraditionalfamilytherapies(e.g.,severalhoursoftreatmentperweekvs.50minutes).

3. Mostimportantly,MSThaswell-documentedlong-termoutcomeswith

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adolescentspresentingseriousantisocialbehaviorandtheadolescents’families.

ThestrongestandmostconsistentsupportfortheeffectivenessofMSTcomesfromcontrolledstudiesthatfocusedonviolentandchronicjuvenileoffenders.Importantly,resultsfromthesestudiesshowedthatMSToutcomesweresimilarforyouthacrosstheadolescentagerange(i.e.,12-17years),formalesandfemales,andforAfricanAmericanaswellasWhiteyouthandfamilies.

EvidenceofProgramEffectivenessThefirstcontrolledstudyofMSTwithjuvenileoffenderswaspublishedin1986,andthreerandomizedclinicaltrialswithviolentandchronicjuvenileoffendershavebeenconductedsincethen.Inthesetrials,MSThasdemonstratedlong-termreductionsincriminalactivity,drug-relatedarrests,violentoffenses,andincarceration.Thissuccesshasledtoseveralrandomizedtrialsandquasi-experimentalstudiesaimedatextendingtheeffectivenessofMSTtootherpopulationsofyouthpresentingseriousclinicalproblemsandtheirfamilies.

Theinformationforthisfactsheetwasexcerptedfrom:

Henggeler,S.W.,Mihalic,S.F.,Rone,L.,Thomas,C.,&Timmons-Mitchell,J.(1998).BlueprintsforViolencePrevention,BookSix:MultisystemicTherapy.Boulder,CO:CenterfortheStudyandPreventionofViolence.

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BIGBROTHERSBIGSISTERSOFAMERICA(BBBSA)

ProgramSummaryBigBrothersBigSistersofAmerica(BBBSA)hasbeenprovidingadultsupportandfriendshiptoyouthfornearlyacentury.Areportin1991demonstratesthatthroughBBBSA’snetworkofnearly500agenciesacrossthecountry,morethan70,000youthandadultsweresupervisedinone-to-onerelationships.

ProgramTargetsBBBSAtypicallytargetsyouth(aged6to18)fromsingleparenthomes.

ProgramContentServicedeliveryisbyvolunteerswhointeractregularlywithayouthinaone-to-onerelationship.Agenciesuseacasemanagementapproach,followingthroughoneachcasefrominitialinquirythroughclosure.Thecasemanagerscreensapplicants,makesandsupervisesthematches,andclosesthematcheswheneligibilityrequirementsarenolongermetoreitherpartydecidestheycannolongerparticipatefullyintherelationship.

BBBSAdistinguishesitselffromothermentoringprogramsviarigorouspublishedstandardsandrequiredprocedures:

■ Orientationisrequiredforallvolunteers.■ VolunteerScreeningincludesawrittenapplication,abackgroundcheck,an

extensiveinterview,andahomeassessment;itisdesignedtoscreenoutthosewhomayinflictpsychologicalorphysicalharm,lackthecapacitytoformacaringbondwiththechild,orareunlikelytohonortheirtimecommitments.

■ YouthAssessmentinvolvesawrittenapplication,interviewswiththechildandtheparent,andahomeassessment;itisdesignedtohelpthecaseworkerlearnaboutthechildinordertomakethebestpossiblematch,andalsotosecureparentalpermission.

■ Matchesarecarefullyconsideredandbasedupontheneedsoftheyouth,abilitiesofvolunteers,preferencesoftheparent,andthecapacityofprogramstaff.

■ Supervisionisaccomplishedviaaninitialcontactwiththeparent,youth,andvolunteerwithintwoweeksofthematch;monthlytelephonecontactwiththevolunteer,parentand/oryouthduringthefirstyear;andquarterlycontactwithallpartiesduringthedurationofthematch.

ProgramOutcomesAnevaluationoftheBBBSAprogramhasbeenconductedtoassesschildrenwhoparticipatedinBBBSAcomparedtotheirnon-participatingpeers.Afteraneighteenmonthperiod,BBBSAyouth:

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■ were46%lesslikelythancontrolyouthtoinitiatedruguseduringthestudyperiod.

■ were27%lesslikelytoinitiatealcoholusethancontrolyouth.■ werealmostone-thirdlesslikelythancontrolyouthtohitsomeone.■ werebetterthancontrolyouthinacademicbehavior,attitudes,andperformance.■ weremorelikelytohavehigherqualityrelationshipswiththeirparentsor

guardiansthancontrolyouth.■ weremorelikelytohavehigherqualityrelationshipswiththeirpeersattheend

ofthestudyperiodthandidcontrolyouth.

ProgramCostsThenationalaveragecostofmakingandsupportingamatchrelationshipis$1,000(£627)peryear.

ProgramBackgroundBigSistersactivitywasinitiatedin1902,whenagroupofwomeninNewYorkCitybeganbefriendinggirlswhocamebeforetheNewYorkChildren’sCourt.KnownthenastheLadiesofCharity,thegrouplaterbecameCatholicBigSistersofNewYork.AstoryintheNewYorkTimesin1902reportedthatajudgeoftheNewYorkChildren’sCourtsecuredpromisesfromagroupofinfluentialmenthateachonewouldbefriendoneboywhohadbeenbeforehiscourt.Hisactivitycouldhaveinfluencedamemberofhiscourt,ClerkErnestK.Coulter,whoiscreditedwithfoundingtheorganizedBigBrothersMovementin1904.ACincinnatibusinessman,IrvinF.Westheimer,andamemberofacloselyknit,charity-mindedJewishcommunity,urgedhisfriendsandbusinessassociatestobefriendtroubledanddisadvantagedyouths,whicheventuallyledtotheorganizationofaBigBrothersagencyinCincinnatiin1910.

BeforeWorldWarI,theBigBrothersandBigSistersMovementwascharacterizedbymanyformsoforganization,underavarietyofsponsors,utilizinganumberofapproaches.Butalloftheeffortswereunitedbyasinglespirit—adesiretohelpchildren,generallyfromone-parenthomes,whosemoral,mental,andphysicaldevelopmentwasendangeredbytheirenvironmentsandbackgrounds.By1922,“standards”(i.e.,basicrequirements)werecreatedandadopted.Theseearlystandardsaddressedtheone-to-onerelationshipasavolunteer’sindividualandpersonaleffortinbehalfofchildren,andassertedtheneedforanagencytomanageitsaffairsinaprofessionalmanner.Bytheearly1930s,thestandardshadbecomemorestringentinsettingforthminimumrequirementsforoperationatthelocallevel.

Inthemid-1930s,theGreatDepressionaffectedtheBigBrothersandBigSistersFederation,andby1937thenationalofficecloseditsdoors,whilelocalagencies

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continuedtooperate.FollowingWorldWarII,anewfederationwasestablishedonlyforBigBrothersagencies.Outofaconvictionthatwomencouldhelpmeettheneedsofgirls,BigSistersInternationalwascreatedbytheBigSistersagenciesthenoperatingin1970.In1977,BigSistersInternationalandBigBrothersofAmericamergedtobecomeBigBrothersBigSistersofAmerica(BBBSA).

EffortsfocusedonthedevelopmentandpilotingofasetofStandardsandRequiredProceduresforOne-To-OneService(BigBrothersBigSistersofAmerica,1986;asamended,1996),whichwereadoptedin1986.Thisconsistsofcorporatemanagementandprogrammanagementstandards,witheachstandardhavingasetofrequiredproceduresthatweredeemednecessarytofulfilleachstandard.CompliancewiththesestandardsandrequiredproceduresbecamethehallmarkofaneffectiveBigBrothersBigSisters(BBBS)agencyandthebasisforbuildingaconsistentone-to-oneserviceofover500BBBSagenciesacrossall50states.AdescriptionofmanualspublishedbyBBBSAcanbefoundinAppendixB.

Duringmorethan85yearsofnationalorganizationaldevelopmentandlocalizedservicedelivery,theword“mentoring”wasnotapartofthemovement’snomenclature.Infact,itwasnotuntilthelate1980s,whenfundersandresearchersdeterminedthatmentoringmaybeapromisingapproachforchildrenat-risk,thatthewordmentoringfounditswayintotheBBBSA’srhetoricfordescribingtheirservice.TherewasastronginclinationonthepartoflocalBBBSagencies,however,tonotconfuseBBBSA’ssystematicandstructuredvolunteerapproachwiththemorelooselyfashionedmentoringprogramsthatwerebeingdeveloped.Mentoringhasvariousdefinitions,dependingontheemphasisthataparticularcommunityyouthprogramhasasitsgoal.“Mentoring”isoftenusedinterchangeablywith“tutoring,”andsometimes,withthegoalofapprenticeship.Mentoringtendstobeanadd-ontoprogramsthathaveveryspecificgoalsandobjectives,withmentoringbeingseenasonlyoneofmanyingredients.Historically,mentoringhashadahelping-to-learnaspecttoit;forexample,anolderpersonguidingayoungerperson,usuallyaroundsomeprescribedactivityoraspectoflife.BigBrothersBigSisterswork,however,focusesonfriendshipastheprimaryaspectoftherelationship,whichshouldleadtoafeelingoftrustovertime,andwhichthenmayleadtosomeaspectsoflearning,regardlessofthesubjectorbehavior.Buttherelationship—thetrust,themutuallysharedexperiencesofeverydaylife—istheessenceoftheservice.Whilethewordmentoringisnowused,forthemostpart,interchangeablywithBigBrothersBigSisters,BBBSA’semphasiscontinuestobeonthequalityoftherelationshipbetweenthevolunteerandthechild,andnotonasetofprescribedactivities.

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TheoreticalRationale/ConceptualFrameworkAlthoughBBBSAwasnotdevelopedwithacademictheoriesofdelinquencyinmind,theproject’srationalemostcloselyresemblessocialcontroltheory.Accordingtothisperspective,attachmentstoprosocialothers,commitmenttosociallyappropriategoals,andinvolvementinconventionalactivitiesrestrainyouthfromengagingindelinquentactivitiesorotherproblembehaviors,becausemoresociallybondedyouthhavemoretolosebymisbehavior.

TherationalethathasguidedBBBSAservicefornearlyacenturyhasbeenthattheconsistentpresenceofanon-familialcaringadultcanmakeadifferenceinthesocial/emotionaldevelopmentofachildoryoungperson,particularlyonegrowingupinasingleparentfamilyorinanadversesituation.OvertheyearsthedevelopmentoftheBBBSservicehasbeenbasedontheoverridingbeliefthataconsistentandfrequentvolunteercontactisapowerfulinfluence.Thisbeliefhasbeenbased,predominantly,onanecdotalreportsfromparents,teachers,casemanagers,andchildrenthemselves.

ThemostrelevantresearchtodatehascomefromtheresiliencystudiescarriedoutbyresearcherssuchasEmmyWerner,andothers,undertherubricof“caringadults.”Werner,ina30yearlongitudinalstudyontheislandofKauai,hasfoundthatthenumberofcaringadultsoutsidethefamilywithwhomthechildlikedtoassociatewasasignificantprotectivefactorforbothhighriskboysandgirlswhomadeasuccessfultransitionintoadulthood.Basedonsuchresearch,BBBSAcontinuesitsgeneralizedapproachandconcentratesonenhancingtheinfrastructuretosupportthedevelopmentandmaintenanceoftherelationshipbetweenthevolunteerandchild.

BriefDescriptionofInterventionBBBSisacommunitymentoringprogramwhichmatchesanadultvolunteer,knownasaBigBrotherorBigSister,toachild,knownasaLittleBrotherorLittleSister,withtheexpectationthatacaringandsupportiverelationshipwilldevelop.Hence,thematchbetweenvolunteerandchildisthemostimportantcomponentoftheintervention.Equallyimportant,however,isthesupportofthatmatchbytheongoingsupervisionandmonitoringofthematchrelationshipbyaprofessionalstaffmember.Theprofessionalstaffmemberselects,matches,monitors,andclosestherelationshipwiththevolunteerandchild,andcommunicateswiththevolunteer,parent/guardian,andthechildthroughoutthematchedrelationship.

Inpractice,thevolunteerinterventioninthetraditionalone-to-onerelationshipwithachildisthreetofivehoursperweek,onaweeklybasis,overthecourseofayearorlonger.Thegeneralizedactivityofthatrelationshipisrelatedtothegoalsthatweresetinitiallywhenthematchwasestablished.Thesegoalsareidentified

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fromtheextensivecasemanagerinterviewheldwiththeparent/guardianandwiththechild.Theforemostgoalusuallysetistodeveloparelationship—onethatismutuallysatisfying,wherebothpartiescometogetherfreelyonaregularbasis.Morespecificgoalsmightrelatetoschoolattendance,academicperformance,relationshipswithotherchildrenandsiblings,generalhygiene,learningnewskillsordevelopingahobby.Thegoalsestablishedforaspecificmatcharedevelopedintoanindividualizedcaseplan,whichisupdatedbythecasemanagerasprogressismadeandcircumstanceschangeovertime.

Generallyspeaking,BBBSagencystaffdonottellavolunteerspecificallywhatactivitiestoengageinwiththechildduringtheirtimetogether,buttheyguidethevolunteerandmakesuggestionsofpossibleactivitiesandapproaches,basedonthechild’sandvolunteer’sinterestsandneeds.Consistencyintherelationshipovertimeisahigherprioritythanthetypesofactivitiesinwhichtheyparticipate.Oncethematchhasbeeninitiallyagreedupon,inthepresenceofthechild,volunteer,andthechild’sparent/guardian,itisthentheresponsibilityoftheprofessionalstaffmember,knownasthecasemanager,tomaintainon-goingcontactwithallpartiesinthematchrelationship.

TheStandardsandRequiredProceduresforOne-To-OneServiceoutlinesthescheduleofcontactsthecasemanageristohavewiththevolunteer,aswellaswiththeparentand/orchild.Thereistobemorefrequentcontactduringtheearlystagesofthematchwithaninitialcontactwithintwoweeksofmakingthematch,thenmonthlycontactthroughouttherestoftheyear,andthencontacteverythreemonthsafterthefirstyearandthroughoutthedurationofthematch.Thecasemanagercallsthevolunteerandtheparentafterthefirstandsecondweekoftherelationshiptodeterminehowtherelationshipisdeveloping,andmaycontinueonaweeklybasisthroughthefirstsixweeks,dependingonthesituation.However,iteventuallydevelopsintoamonthlycontactwiththevolunteerandtheparent.

Atleastquarterly,thecasemanagerisintouchwiththechildtolearnoftheyouth’sexperiences.Thesesupervisorycontactsinformthecasemanagerhowtherelationshipisdevelopingandprovideanopportunitytogiveadviceandguidancearoundanyissuesthevolunteermighthave,aswellastoencourageandsupportvariousactivities.Formostagencies,theon-goingcasemanagersupervisionwiththevolunteertakesplaceoverthephone.Thecasemanageristoassessthematchgoalsonanannualbasisandmakeappropriateadjustmentstothecaseplan.

EvidenceofProgramEffectivenessIncontrasttopriorresearchonmentoringprogramswhichhasfailedtodemonstratetheeffectivenessofthoseprograms,researchconductedbyPublic/PrivateVentures(P/PV)ontheBBBSmodelprovidesclearevidencethatacaring

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relationshipbetweenanadultvolunteerandayoungpersoncanprovideawiderangeoftangiblebenefits.

P/PVconductedacomparativestudyofnearly1,000ten-tosixteen-yearoldsfromeightBBBSagenciesduringtheyears1992-1993.Halfoftheseyoungpeoplewererandomlyassignedtoatreatmentgroup,forwhichBBBSmatchesweremade;theotherhalfwererandomlyassignedtoacontrolgroupandwerenotmatched(thecontrolgroupmemberswereputonawaitinglistfor18months).TheP/PVstudycomparedthesetwogroupsafteran18monthperiodoftime.

Attheconclusionofthe18-monthstudyperiod,itwasfoundthatLittleBrothersandLittleSisters(youthparticipantsintheprogram)werelesslikelytohavestartedusingdrugsoralcohol,werelesslikelytohavehitsomeone,feltmorecompetentaboutdoingschoolwork,attendedschoolmore,gotbettergrades,andhadbetterrelationshipswiththeirparentsandpeersthanthosewhodidnotparticipateintheprogram.


McGill,D.E.,Mihalic,S.F.,&Grotpeter,J.K.(1998).BlueprintsforViolencePrevention,BookTwo:BigBrothersBigSistersofAmerica.Boulder,CO:CenterfortheStudyandPreventionofViolence.

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FUNCTIONALFAMILYTHERAPY(FFT)ProgramSummaryFunctionalFamilyTherapy(FFT)isanoutcome-drivenprevention/interventionprogramforyouthwhohavedemonstratedtheentirerangeofmaladaptive,actingoutbehaviorsandrelatedsyndromes.

ProgramTargetsYouth,aged11-18,atriskforand/orpresentingwithdelinquency,violence,substanceuse,ConductDisorder,OppositionalDefiantDisorder,orDisruptiveBehaviorDisorder.Oftentheseyouthpresentwithadditionalcomorbidchallengessuchasdepression.

ProgramContentFFTrequiresasfewas8-15sessionsofdirectservicetimeforcommonlyreferredyouthandtheirfamilies,andgenerallynomorethan26totalsessionsofdirectserviceforthemostsevereproblemsituations.

DeliverymodesFlexibledeliveryofservicebyoneand(rarely)twopersonteamstoclientsin-home,clinic,school,juvenilecourt,communitybasedprograms,andattimeofre-entryfrominstitutionalplacement.

ImplementationWiderangeofinterventionists,includingtrainedprobationofficers,mentalhealthtechnicians,degreedmentalhealthprofessionals(e.g.,M.S.W.,Ph.D.,M.D.,R.N.,M.F.T.,L.C.P.).

FFTeffectivenessderivesfromemphasizingfactorswhichenhanceprotectivefactorsandreducerisk,includingtheriskoftreatmenttermination.Inordertoaccomplishthesechangesinthemosteffectivemanner,FFTisaphasicprogramwithstepswhichbuilduponeachother.Thesephasesconsistof:

■ Engagement,designedtoemphasizewithinyouthandfamilyfactorsthatprotectyouthandfamiliesfromearlyprogramdropout;

■ Motivation,designedtochangemaladaptiveemotionalreactionsandbeliefs,andincreasealliance,trust,hope,andmotivationforlastingchange;

■ Assessment,designedtoclarifyindividual,familysystem,andlargersystemrelationships,especiallytheinterpersonalfunctionsofbehaviorandhowtheyrelatedtochangetechniques;

■ BehaviorChange,whichconsistsofcommunicationtraining,specifictasksandtechnicalaids,basicparentingskills,problemsolvingandconflictmanagementskills,contractingandresponse-costtechniques;and

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■ Generalization,duringwhichfamilycasemanagementisguidedbyindividualizedfamilyfunctionalneeds,theirinterfacewithcommunitybasedenvironmentalconstraintsandresources,andthealliancewiththeFFTtherapist/FamilyCaseManager.

ProgramOutcomesClinicaltrialshavedemonstratedthatFFTiscapableof:

■ EffectivelytreatingadolescentswithConductDisorder,OppositionalDefiantDisorder,DisruptiveBehaviorDisorder,alcoholandotherdrugabusedisorders,andwhoaredelinquentand/orviolent;

■ Interruptingthematriculationoftheseadolescentsintomorerestrictive,highercostservices;

■ Reducingtheaccessandpenetrationofothersocialservicesbytheseadolescents;

■ Generatingpositiveoutcomeswiththeentirespectrumofinterventionpersonnel;

■ Preventingfurtherincidenceofthepresentingproblem;■ Preventingyoungerchildreninthefamilyfrompenetratingthesystemofcare;■ Preventingadolescentsfrompenetratingtheadultcriminalsystem;and■ Effectivelytransferringtreatmenteffectsacrosstreatmentsystems.

ProgramCostsThe90-daycostsrangebetween$1,600and$5,000foranaverageof12homevisitsperfamily.Currentcostsvaryandarehighlydependentoncostoflabor.

ProgramBackgroundManytherapiesarenamedtoreflectatheoreticalperspective(e.g.,behavioral,objectrelations)oraprimaryfocus(e.g.,multiplesystems,cognitive).FunctionalFamilyTherapy(FFT)isnamedtoreflectasetofcoretheoreticalprincipleswhichrepresentstheprimaryfocus(family),andanoverridingallegiancetopositiveoutcomeinamodelthatunderstandsbothpositiveandnegativebehaviorasrepresentationsoffamilyrelationalsystems(functional).Thus,FunctionalFamilyTherapyhasadoptedanintegrativestancethatstressesfunctionalityofthefamily,thetherapy,andtheclinicalmodel.

ThedevelopersandreplicatorsofFunctionalFamilyTherapyhaverecognizedthatsolutionsrequireanintegrationofhighqualityscience,testedtheoreticalprinciples,andextensiveclinicalexperienceinpursuitofspecificfunctionalgoalsof:

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1. Effectivelychangingthemaladaptivebehaviorsofyouthandfamilies,especiallythosewhoattheoutsetmaynotbemotivatedormaynotbelievetheycanchange

2. Reducingthepersonal,societal,andeconomicdevastationthatresultsfromthecontinuationorexacerbationofthevariousdisruptivebehaviordisordersofyouth

3. Doingsowithlesscost,intermsoftimeandmoney,thansomanyofthemoreexpensive(butnotnecessarilyeffective)treatmentscurrentlyavailable.

Unlikeothertherapies,FFTwasnotdevelopedoncollegestudents,neuroticindividuals,orinpatientadults.Instead,FFTgrewoutofaneedtoserveapopulationofat-riskadolescentsandfamiliesthatwereunderserved,hadfewresources,weredifficulttotreat,andwereoftenperceivedbyhelpingprofessionstobetreatmentresistant.Inmanycasesthesefamiliesenteredthe“system”angry,resistant,andunmotivatedtochange.Essentiallythe“helpingprofessions”didnotknowhowtotreatthispopulation.FFTdevelopedoutoftheawarenessthattobesuccessfulintreatmentofthispopulationweneededtobeculturallycompetent,andunderstandwhythisgroupwassotreatmentresistant.Thus,FFTattemptedtodevelopwaystoengagethesefamiliesinordertohelpthemachieveobtainablechangeandbecomemoreadaptableandproductive.Overthelast30years,FFThaslearnedthatitisimportanttodomorethansimplystoppingbadbehaviors.Weknowthatitisimportanttomotivatefamiliestochangeinapositivewaybyuncoveringanddevelopingtheuniquestrengthsofthefamilyinwaysthatenhancethefamilies’self-respectwhileprovidingspecificwaystoimprove.

Sinceitsinceptionin1969,FFThasaccomplisheditsprimarygoalsbyintegratingthemostpromisingtheoreticalperspectives,theempiricaldataavailable,andhoursandhoursofdirectclinicalexperiencewiththetroubledyouthwewantedtohelp.FFTisdesignedtoincreaseefficiency,decreasecosts,andenhanceourabilitytoprovideservicetomoreyouthby:

1. Targetingriskandprotectivefactorsthatwecan,infact,changeandthenprogrammaticallychangingthem;

2. Engagingandmotivatingthefamiliesandyouthsotheyparticipatemoreinthechangeprocess;

3. Enteringeachsessionandphaseofinterventionwithaclearplanandbyusingproventechniquesforimplementation;

4. Constantlymonitoringprocessandoutcomesowedon’tfoolourselvesormakeexcusesforfailure;and

5. Believinginthefamiliesweseeandthenbelievinginourselves.

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AtthetimeoftheinceptionofFunctionalFamilyTherapy,themajortheoreticalperspectivesandservicesavailablefortreatingtroubledyouthinafamilycontextwererudimentary,thoughpromising.Earlyon,FFTrepresentedanintegrationofsystemsperspectivesandbehavioraltechniques.ThesystemicbackgroundofFFTemphasizeddynamicandreciprocalprocesseswhichneededtobeidentifiedinreferredfamilies.Thisledtoearlyobservationalresearchontheinteractionsofdelinquentandnon-delinquentfamiliesusingasystemicframework.ThebehavioralbackgroundofFFTprovidednotonlyspecific,manualizeableinterventionssuchascontracting,butitalsofeaturedanurgentawarenessoftheneedforrigoroustreatmentdevelopment-ascientificimperativetosystematicallyexaminetheeffectsofinterventionanddevelopstrategiesforidentifyingpositivechangeprocesses.Theseoriginsledtoacontinuingseriesofstudiesinvolvingcontrolledoutcomeevaluationsandadditionalreplications.Duringthemid-1970’s,FFTalsobeganaddressingissuesoftherapistcharacteristicsandin-sessionprocessesfromanintegratedclinical/researchperspective,bothreflectingandcontributingtothetrainingoftherapistsforsubsequentinterventions.Inthelate1990’sFFTfurtherarticulatedtheclinicalchangemodeladdingacomprehensivesystemofclient,process,andoutcomeassessmentimplementedthroughacomputer-basedclienttrackingandmonitoringsystem(FFT-CSS).

ThroughoutitsdevelopmentFFThasinsistedonstepbystepdescriptionsoftheclinicalchangeprocessaswellasrigorousevaluationofboththeprocessandoutcomesofthiswork.FFThasalsoinsistedonintegratinghighqualityscience(inregardtoevaluationandresearch)withsoundclinicaljudgementandexperienceandcomprehensivetheoreticalprinciples.Thus,overthelast30yearsFFThasbeenadynamicandevolvingclinicalsystemthatretainsitscoreprincipleswhileaddingclinicalfeaturesthatfurtherenhancesuccessfuloutcomes.Initsmostrecentiteration,FFThasdevelopedafunctionalfamilyassessmentsystemtoaidFFTtherapistsintargetingandimplementingtherapeuticchangegoalsinawaythatleadstoaccountabilitythroughprocessandoutcomeevaluation.Thus,FFThasmaturedintoaclinicalinterventionmodelwithsystematictraining,supervision,andprocessandoutcomeassessmentcomponentsalldirectedatenhancingthedeliveryofFFTinlocalcommunities(seeFigure1).

BriefDescriptionofInterventionFunctionalFamilyTherapy(FFT)isawelldocumentedfamilypreventionandinterventionprogramwhichhasbeenappliedsuccessfullytoawiderangeofproblemyouthandtheirfamiliesinvariouscontexts.Whilecommonlyemployedasaninterventionprogram,FFThasdemonstrateditseffectivenessasamethodforthepreventionofmanyoftheproblemsofat-riskadolescentsandtheirfamilies.FunctionalFamilyTherapy(FFT)isanempiricallygroundedinterventionprogram

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thattargetsyouthbetweentheagesof11and18,althoughyoungersiblingsofreferredadolescentsarealsotreated.FFTisashort-terminterventionwith,onaverage,8to12one-hoursessionsformildcasesandupto26to30hoursofdirectserviceformoredifficultsituations.Inmostprogramssessionsarespreadoverathree-monthperiodoftime.Targetpopulationsrangefromat-riskpreadolescentstoyouthwithveryseriousproblemssuchasconductdisorder.Thedatafromnumerousoutcomestudiessuggeststhatwhenappliedasintended,FFTcanreducerecidivismbetween25%and60%.AdditionalstudiessuggestthatFFTisacost-effectiveinterventionthatcan,whenappropriatelyimplemented,reducetreatmentcostswellbelowthatoftraditionalservicesandotherfamily-basedinterventions.

Practice SitesWashington StateImplementation

CSPV Blueprint Project (8 sites)Nevada

UtahPennsylvania

VirginiaArizonaIndianaKansasFlorida

KentuckyDelwareClinical Practice Training

Supervision

Science

Clinical ServicesSystem

Clinical monitoring/tracking

Family/AdolescentAssessment

ProtocolClient Assessment

Process AssessmentOutcome Assessment

Externship

Clinical Training Supervision

FFT Clinical Model

FFT-PRNPractice Research

Network

Adherence StudiesThe Family Project/

UNLV

Clinical Trials

Effectiveness StudiesThe Family Project/

UNLV

Process StudiesCTRADA Study 2

Univ. Utah

Figure1:MatureClinicalModel

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Asitdeveloped,FFThasbeenreadilyadoptedinmanycontextsduetoitsclearidentificationofspecificphases,eachofwhichincludesdescriptionsofgoals,requisitetherapistcharacteristics,andtechniques.Thephasesofintervention,andtheircomponentactivities,havedevelopedinthecontextofmanyclinicalhourswithmanyfamiliesofvariouscharacteristics,coupledwithintensivesupervisionandclinicalcasediscussion.Asaresult,eachphaseinvolvesclinicallyrichandsuccessfulinterventionsthatareorganizedinacoherentmannerandallowclinicianstomaintainfocusinthecontextofconsiderablefamilyandindividualdisruption.Thephasesconsistof:

1. Phase 1: Engagement and Motivation.Duringtheseinitialphases,FFTappliesreattribution(e.g.,reframing)andrelatedtechniquestoimpactmaladaptiveperceptions,beliefs,andemotions.Thisproducesincreasinghopeandexpectationofchange,decreasingresistance,increasingallianceandtrust,reducingtheoppressivenegativitywithinfamilyandbetweenfamilyandcommunity,andincreasingrespectforindividualdifferencesandvalues.

2. Phase 2: Behavior Change.Thisphaseappliesindividualizedanddevelopmentallyappropriatetechniquessuchascommunicationtraining,specifictasksandtechnicalaids,basicparentingskills,andcontractingandresponse-costtechniques.

3. Phase 3: Generalization.Inthisphase,FamilyCaseManagementisguidedbyindividualizedfamilyfunctionalneeds,theirinteractionwithenvironmentalconstraintsandresources,andthealliancewiththetherapist.

Eachofthesephasesinvolvesbothassessmentandinterventioncomponents.Familyassessmentfocusesoncharacteristicsoftheindividualfamilymembers,familyrelationaldynamics,andthemultisystemiccontextinwhichthefamilyoperates.Thefamilyrelationalsystemisdescribedinregardtointerpersonalfunctionsandtheirimpactonpromotingandmaintainingproblembehavior.Interventionisdirectedataccomplishingthegoalsoftherelevanttreatmentphase.Forexample,intheengagementandmotivationphase,assessmentisfocusedondeterminingthedegreetowhichthefamilyoritsmembersarenegativeandblaming.Thecorrespondinginterventionwouldtargetthereductionofnegativityandblaming.Inbehaviorchange,assessmentwouldfocusontargetingtheskillsnecessaryformoreadaptivefamilyfunctioning.Interventionwouldbeaimedathelpingthefamilydevelopthoseskillsinawaythatmatchedtheirrelationalpatterns.Ingeneralization,theassessmentfocusesonthedegreetowhichthefamilycanapplythenewbehaviorinbroadercontexts.Interventionswouldfocusonhelpinggeneralizethefamilybehaviorchangeintosuchcontexts.

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Asaclinicalmodel,FFThasbeenconductedinvariedclinicalsettingsandasahome-basedmodel.ThefidelityoftheFFTmodelisachievedbyaspecifictrainingmodelandasophisticatedclientassessment,tracking,andmonitoringsystemthatprovidesforspecificclinicalassessmentandoutcomeaccountability(FFT-CSS).TheFFTPracticeResearchNetwork(FFT-PRN)allowsclinicalsitestoparticipateinthedevelopmentanddisseminationofFFTmodelinformation.

EvidenceofProgramEffectivenessTodate,thirteenstudiesinreferencedjournals(plusoneinpreparation)demonstratedramaticandsignificantpositivetreatmenteffects,includingfollow-upperiodsofuptofiveyears.Ratesofoffendingandfostercareorinstitutionalplacementhavebeenreducedatleast25percentandasmuchas60percentincomparisontotherandomlyassignedormatchedalternativetreatments,orbaserates.Onestudyalsodemonstratedapositivethreeyearfollow-upeffectonsiblings.Additionalformalprogramreports(e.g.,countyandfederalfundedprojects)fromcompletedandongoingreplicationsreflectsimilarpositiveoutcomes,andfivecurrentlyfundedtrials(NationalInstituteofDrugAbuse,NationalInstituteofAlcoholAbuseandAlcoholism,GovernmentofSweden)promiseadditionaldataregardinggeneralizationofeffectsforFFTacrossmorecontextsandpopulations.StudieshavealsoidentifiedspecificFFTbasedinterventionsanddirectchangesinfamilyfunctioningwhichrelatetotheoutcomefindings.

OnemajorfactorinthesuccessfulevolutionofFFThasbeenthecontinuous(29year)involvementofitsprogenitorsandmanyofitsco-contributorsinvariousuniversitysettings.Thiscontexthasnotonlymaintainedastandardofscientificscrutiny,buthasalsocontributedtotheconceptualintegrityofthemajorconstructsandtechniques.TheprimeexampleofthisimpactistheextensiveworkonreframinginFFT,informedbyotherwell-developedtheoreticalperspectivessuchasinformationprocessingtheory,socialcognition,andthepsychologyofemotion.Laboratorybasedresearchhasidentifiedspecificcomponentsofthiscriticaltechnique,whichinturnhasledtoappliedresearchoncognitivesetandattributionalprocessesinreferredadolescentfamilies.Further,investigationshaveidentifiedin-sessiontherapistcharacteristicsandfamilyinteractionprocessesrelevanttothephasesofFFTwhicharepredictiveofpositivechange.Mostnotableprocesschangesappeartobeinfamilycommunicationpatterns,andespeciallynegative/blamingcommunicationsand“withholding”typesofsilence.Withrespecttotherapistcharacteristics,processandoutcomedatademonstratethatFFTtherapistsmustbefirstrelationallysensitiveandfocused,thencapableofclearstructuringandteaching,inordertoproducesignificantlyfewerdropoutsduringtreatmentandlowerrecidivism.

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Morerecently,FFThasbeenwidelyadoptedbecauseithasevolvedanincreasinglymulticulturalperspective,andhasaddedeffectivehome-basedintervention.Inthehome-basedClarkCounty,Nevada,YouthandFamilyServicesprogram,forexample,referredadolescentsareroughly30percentAfricanAmerican,20percentHispanic/Latino(mostlyMexicanAmerican),andjustunder50percentEuropeanAmericanwithafewAmericanIndianandAsianAmericanyouth.PreliminarydataonthefirstyearofFFTinvolvementindicatenodifferenceinreoffendingrateamongthedifferentethnic/racialgroups,supportingthegeneralizabilityofFFTeffectsacrosscultural/racialgroups.TheFayetteville,NorthCarolina,programhasinvolvedprimarilyWhiteandAfricanAmericanfamiliesandtherapists,includingasignificantnumberofmixedracerelationshipsandoffspring.ThetwoclinicaltrialsbeingconductedinNewMexicoinvolveHispanic/LatinoandWhiteyouth,andthehome-basedprograminurbanWillowRun,Michigan,involvesalargeproportionofAfricanAmericanandmixedfamilies.(Seereplicationinformationinlatersectionsformoredetails.)Asthemodelhasbeenincreasinglyadoptedinmulticulturalcontexts,focusisbeingplacedonissuesofcultureandethnicity,withmuchofthisrecentworkundertakeninthecontextofthemulti-siteNationalInstituteofDrugAbuse(NIDA)fundedCenterforResearchonAdolescentDrugAbuse(CRADA,HowardLiddle,P.I.).

Takentogether,28yearsofdataandclinicalexperiencewithFFTinvolvinghundredsoftherapistsandthousandsoffamilieshaveprovidedstrongempiricalsupportforthisfamily-basedinterventionwithadolescents.Inaddition,theresearchhasdemonstratedthatinterventionmustincludeamajorfocusonchangingemotionalandattributional,especiallyblaming,componentsoffamilyinteraction,thenprovideaprogramofspecificbehaviorchangetechniquesthatareculturallyappropriate,familyappropriate,andconsistentwiththecapabilitiesofeachfamilymember.


Alexander,J.,Barton,C.,Gordon,D.,Grotpeter,J.,Hansson,K.,Harrison,R.,Mears,S.,Mihalic,S.,Parsons,B.,Pugh,C.,Schulman,S.,Waldron,H.,&Sexton,T.(1998).BlueprintsforViolencePrevention,BookThree:FunctionalFamilyTherapy.Boulder,CO:CenterfortheStudyandPreventionofViolence.

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LIFESKILLSTRAINING(LST)

ProgramSummaryTheresultsofoveradozenstudiesconsistentlyshowthattheLifeSkillsTraining(LST)programdramaticallyreducestobacco,alcohol,andmarijuanause.Thesestudiesfurthershowthattheprogramworkswithadiverserangeofadolescents,producesresultsthatarelong-lasting,andiseffectivewhentaughtbyteachers,peerleaders,orhealthprofessionals.

ProgramTargetsLSTisaprimaryinterventionthattargetsallmiddle/juniorhighschoolstudents(initialinterventioningrades6or7,dependingontheschoolstructure,withboostersessionsinthetwosubsequentyears).

ProgramContentLSTisathree-yearinterventiondesignedtopreventorreducegatewaydruguse(i.e.,tobacco,alcohol,andmarijuana),primarilyimplementedinschoolclassroomsbyschoolteachers.Theprogramisdeliveredin15sessionsinyearone,10sessionsinyeartwo,and5sessionsinyearthree.Sessions,whichlastanaverageof45minutes,canbedeliveredonceaweekorasanintensivemini-course.Theprogramconsistsofthreemajorcomponentswhichteachstudents(1)generalself-managementskills,(2)socialskills,and(3)informationandskillsspecificallyrelatedtodruguse.Skillsaretaughtusingtrainingtechniquessuchasinstruction,demonstration,feedback,reinforcement,andpractice.

ProgramOutcomesUsingoutcomesaveragedacrossmorethanadozenstudiesconductedwithLST,ithasbeenfoundto:

■ Cuttobacco,alcohol,andmarijuanause50%-75%.

Long-termfollow-upresultsobservedsixyearsfollowingtheinterventionshowthatLST:

■ Cutspolydruguseupto66%;■ Reducespack-a-daysmokingby25%;and■ Decreasesuseofinhalants,narcotics,andhallucinogens.

ProgramCostsLSTcanbeimplementedatacostofapproximately$7perstudentperyear(curriculummaterialsaveragedoverthethree-yearperiod).Thisdoesnotincludethecostoftrainingwhichisaminimumof$2,000perdayforoneortwodays.

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ProgramBackgroundTheLifeSkillsTraining(LST)programwasdevelopedtoaddressthemonumentalproblemofsubstanceabuseinthiscountry.Theadversehealth,social,andlegalconsequencesofthisproblemhavebeenwelldocumented.Cigarettesmokingisarisk-factorforheartdisease,variouscancers,andchronicobstructivelungdiseaseandaccountsforover430,000deathsperyear.Alcoholisnotonlyrelatedtochronicdiseasessuchascirrhosisoftheliver,butisalsoamajorfactorinautofatalitiesandhomicides.Beyondthis,adolescentdrugusepredictsanumberofotherundesirableoutcomessuchasreducingtraditionaleducationalaccomplishmentsandjobstability,increasingthelikelihoodofmarryingandhavingchildrenatyoungerages,andincreasingthelikelihoodofengagingincriminalbehavior.

Despiteconsiderablepublicattentionandtheexpenditureofwelloverabilliondollarsinthepastfewyearsalone,littleifanyprogresshasbeenmadetowardreducingdrugabuse.Atpresent,druguseamongAmericanyouthisaproblemofenormousproportionsanditisgettingworse.Since1991,accordingtonationalsurveys,drugusehasincreasedbymorethan30percentleadingsomeexpertstobelievethatweareonthevergeofanewdrugepidemic.Figure1illustratesthistrendinannualprevalence(proportionofusers)ofillicitdrugusefortwelfthgradestudentssince1975.Accordingtothemostrecentnationalsurveydata,thefollowingproportionsofhighschoolstudentshaveusedalcohol,cigarettes,andillicitdrugsatleastonce(Johnston,O’Malley&Bachman,1995):

Alcohol Cigarettes Illicit Drugs8thGraders 56% 46% 26%

10thGraders 71% 57% 37%

12thGraders 80% 62% 46%

Resultsfromthesamesurveyindicatedthatduringthepast30days,thefollowingproportionsofhighschoolstudentsusedthefollowingsubstancesoneormoretimes:

Alcohol Cigarettes Illicit Drugs8thGraders 26% 19% 11%

10thGraders 39% 25% 19%

12thGraders 50% 31% 22%

Forsomeoftheseteens,usemaybediscontinuedafterabriefperiodofexperimentation.However,formany,initiationofcigarettesmoking,drinking,ordrug-takingmayleadtopatternsofusewhichresultinbothpsychologicalandphysicaldependence.Ingeneral,programsdesignedtohelpindividualsquit

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smoking,drinking,orusingdrugshaveonlybeenmoderatelyeffective.Quitesimply,onceanytypeofsubstanceusehabitisacquireditisextremelydifficulttobreak.Scientificevidencenowsuggeststhatthedevelopmentofeffectivepreventionprogramsmayofferthegreatestpotentialforimpactingthisimportanthealthproblem.

Unfortunately,reviewsofthepreventionresearchliteratureandmeta-analyticstudiesshowthatmanywidelyuseddrugabusepreventionapproachesareineffective.Themostcommonapproachestosubstanceabusepreventionoverthepasttwodecadeshaveinvolvedeitherthepresentationoffactualinformationconcerningthedangersofsubstanceuseorwhathasbeenreferredtoas“affective”education.

Approachesrelyingontheprovisionoffactualinformationarebasedlargelyontheassumptionthatincreasedknowledgeaboutpsychoactivesubstancesandtheiradverseconsequenceswouldbeaneffectivedeterrent.Affectiveeducationapproachesaredesignedtoenrichthepersonalandsocialdevelopmentofstudentsthroughclassdiscussionandexperimentalclassroomactivities.Bothoftheseapproacheshaveproventobelargelyineffectivebecausetheydonotaddressthefactorspromotingtheinitiationandearlystagesofsubstanceuse/abuse.

TheLSTprogramisadrugabusepreventionprogramthatisbasedonanunderstandingofthecausesofsmoking,alcohol,anddruguse/abuse.TheLSTinterventionhasbeendesignedsothatittargetsthepsychosocialfactorsassociatedwiththeonsetofdruginvolvement.Withthisinmind,theprogramimpactsondrug-relatedexpectancies(knowledge,attitudes,andnorms),drug-relatedresistanceskills,andgeneralcompetence(personalself-managementskillsandsocialskills).Increasingprevention-relateddrugknowledgeandresistanceskillscanprovideadolescentswiththeinformationandskillsneededtodevelopanti-drugattitudesandnorms,aswellastoresistpeerandmediapressuretousedrugs.Teachingeffectiveself-managementskillsandsocialskills(improvingpersonalandsocialcompetence)offersthepotentialofproducinganimpactonasetofpsychologicalfactorsassociatedwithdecreaseddrugabuserisk(byreducingintrapersonalmotivationstousedrugsandbyreducingvulnerabilitytopro-drugsocialinfluences).

TheoreticalRationale/ConceptualFrameworkManytheorieshavebeenadvancedtoexplaindrugabuse.Themostprominentamongthesefocusonsociallearning,problembehaviors,self-derogation,persuasivecommunications,peerclusters,andsensation-seeking.However,theetiologyofdrugabuseinvolvesadynamicprocesswhichunfoldsovermanyyears.

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Acommonlimitationofmosttheoreticalmodelsisthattheyareessentiallysnap-shotsoftheetiologyofdrugabuseanddonotadequatelycapturethecomplexityoftheproblem.

Wenowknowthattheinitiationofdruguseistheresultofthecomplexcombinationofmanydiversefactors.Thereisnosinglepathwayorsinglevariablewhichservesasanecessaryandsufficientconditionforthedevelopmentofeitherdruguseordrugabuse.Withthisinmind,theLSTapproachtodrugabusepreventionisbasedonaperson-environmentinteractionistmodelofdrugabuse.Likeothertypesofhumanbehavior,drugabuseisconceptualizedasbeingtheresultofadynamicinteractionofanindividualandhis/herenvironment.Socialinfluencestousedrugs(alongwiththeavailabilityofdrugs)interactwithindividualvulnerability.Someindividualsmaybeinfluencedtousedrugsbythemedia(TVshowsandmoviesglamorizingdruguseorsuggestingthatdruguseisnormalorsociallyacceptableaswellasadvertisingeffortstopromotethesaleofalcoholandtobaccoproducts),byfamilymemberswhousedrugsorconveypro-drugattitudes,and/orbyfriendsandacquaintanceswhousedrugsorholdattitudesandbeliefssupportiveofdruguse.Othersmaybepropelledtowarddruguseoradrug-usingpeergroupbecauseofintrapersonalfactorssuchaslowself-esteem,highanxietyorotherdysphoricfeelings,ortheneedforexcitement.

Sincetherearemultiplepathwaysleadinginitiallytodruguseandlatertodrugabuse,amoreusefulwayofconceptualizingdrugabuseisfromarisk-factorperspectivesimilartothatusedintheepidemiologyofchronicdiseasessuchascancerandheartdisease.Fromthisperspective,thepresenceofspecificriskfactorsislessimportantthantheiraccumulation.Asmoreriskfactorsaccumulatesodoesthelikelihoodthatanindividualwillbecomeadruguserandeventuallyadrugabuser.Thus,thepresenceofmultipleriskfactorsisassociatedwithbothinitialdruguseandtheseverityofdruginvolvement.

Ithasalsobeenwellestablishedthattheprevalenceofdrugusegenerallyincreaseswithageandprogressesinawell-definedsequence.Drugusetypicallybeginswiththeuseofalcoholandtobaccofirst,progressinglatertotheuseofmarijuana,and,forsome,totheuseofstimulants,opiates,hallucinogens,andotherillicitsubstances.Notsurprisingly,thisprogressioncorrespondsexactlytotheprevalenceandavailabilityofthesesubstanceswithalcoholbeingthemostprevalentformofdruguseandthemostwidelyavailable,followedbytobacco(cigarettes)andmarijuana.Becausealcohol,tobacco,andmarijuanaareamongthefirstsubstancesused,theyhavebeenreferredtoas“gateway”substances.Theuseofthese“gateway”substancessignificantlyincreasestheriskofusingillicitdrugsotherthanmarijuana.

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Takingthisintoaccount,theLSTpreventionprogramtargetsthose“gateway”substances(tobacco,alcohol,andmarijuana)thatoccuratthebeginningofthedevelopmentalprogression.Thus,LSToffersthepotentialforinterruptingthenormaldevelopmentalprogressionfromuseofthesesubstancestootherformsofdruguse/abuse.Asecondreasonfortargetingthistypeofdruguseisthattheuseofthesesubstancesaccountsforthelargestportionofdrug-relatedannualmortalityandmorbidity.

BriefDescriptionofIntervention

OverviewTheLSTpreventionprogramisathree-yearinterventiondesignedtobeconductedinschoolclassrooms.Basedonthetheoreticalframeworkdiscussedearlier,theLSTprogramwasdevelopedtoimpactondrug-relatedknowledge,attitudesandnorms;teachskillsforresistingsocialinfluencestousedrugs;andpromotethedevelopmentofgeneralpersonalself-managementskillsandsocialskills.Consistentwiththis,theLSTpreventionprogramcanbestbeconceptualizedasconsistingofthreemajorcomponents.Thefirstcomponentisdesignedtoteachstudentsasetofgeneralself-managementskills.Thesecondcomponentfocusesonteachinggeneralsocialskills.Thethirdcomponentincludesinformationandskillsthatarespecificallyrelatedtotheproblemofdrugabuse.Thefirsttwocomponentsaredesignedtoenhanceoverallpersonalcompetenceanddecreaseboththemotivationstousedrugsandvulnerabilitytodrugusesocialinfluences.Theproblem-specificcomponentisdesignedtoprovidestudentswithmaterialrelatingdirectlytodrugabuse(drugresistanceskills,anti-drugattitudes,andanti-drugnorms).AcompletedescriptionofeachLSTcomponentmaybefoundinthesectionlabeled“ProgramasDesignedandImplemented.”

ProgramStructureTheLSTprogramconsistsoffifteenclassperiods(roughly45minuteseach)andisintendedformiddleorjuniorhighschoolstudents,dependinguponthestructureoftheschool.Aboosterinterventionhasalsobeendevelopedwhichconsistsoftenclassperiodsinthesecondyearandfiveclassperiodsinthethirdyear.Thismeansforschooldistrictswithamiddleschoolstructure,theLSTprogramcanbeimplementedwithstudentsinthesixthgrade,followedbyboostersessionsintheseventhandeighthgrades.IftheLSTprogramisimplementedinajuniorhighschoolsetting,studentsreceivetheprogramintheseventhgrade,andtheboostersessionsintheeighthandninthgrade,respectively.TherationaleforimplementingtheLSTprogramatthispointconcernsavarietyoffactorsconcerningthedevelopmentalprogressionofdruguse,normalcognitiveandpsychosocialchangesoccurringatthistime,theincreasingprominenceofthepeergroup,andissuesrelatedtothetransitionfromprimarytosecondaryschool.

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Drugexpertshaveestablishedthatearlyadolescenceisatimeofincreasedriskforexperimentingwithoneormorepsychoactivesubstances.Childrenfirsttypicallyexperimentwithalcoholduringthesixthandseventhgrades.Thegreatestproportionalchangeincigarettesmokingoccursbetweentheseventhandeighthgrades.Correspondingly,thegreatestchangeinmarijuanausetakesplacebetweentheeighthandninthgrades.Adolescenceisalsoatimeofincreasedrelianceonthepeergroup,separationfromparentsastheydevelopasenseofindependenceandautonomy,andchangesinthewayindividualsthink.Forexample,duringthistime,individualsbegintoshiftfromaconcretestyleofthinkingthatincludesaclearsenseofrightandwrongorabsoluterulesofbehaviortoonethatismorerelativeandhypothetical.Thisenablestheadolescenttoacceptdeviationfromestablishedrulesandtorecognizethefrequentlyirrationalandinconsistentnatureofadultbehavior.Inaddition,ithasbeennotedthatthetransitionfromprimarytosecondaryschoolcanbeasourceofstressthatincreasesriskfromproblembehaviorssuchastobacco,alcohol,andillicitdruguse.Finally,thestrongestevidenceconcerningtheeffectivenessofdrugabusepreventionprogramsisbasedonevaluationresearchwithprogramsimplementedwithindividualsduringthisperiod.

Whiletheprogramiseffectivewithjusttheoneyearofprimaryintervention,researchalsohasshownthatpreventioneffectsaregreatlyenhancedwhenboostersessionsareincluded.Forexample,twostudieshaveshownthatoneyearoftheprimaryinterventionofLSTproducedreductionsof56-67percentinsmokingwithoutanyadditionalboostersessions;butforthosestudentsreceivingboostersessions,thesereductionswereashighas87percent.Inaddition,theboostersessionsenhancethedurabilityofpreventioneffects,sothattheydonotdecayasmuchovertime.LSThasbeenshowntobeeffectiveusingavarietyofserviceprovidersincludingoutsidehealthprofessionals,regularclassroomteachers,andpeerleaders.Peercounselorsareoftenslightlyolder(highschool)andalmostalwaysworkinconjunctionwithatrainedadultprovider.

EvidenceofProgramEffectiveness

OverviewConsiderablepreventionresearchhasbeenconductedoverthepasttwentyyears.Despitethebesteffortsofeducators,healthprofessionals,anddrugabusepreventionspecialists,alargenumberofevaluationstudieshavefailedtodemonstratethatthepreventionapproachbeingutilizedwasabletoproduceameasurableimpactondrugusebehavior.Somestudieshavedemonstratedreductionsinattitudestowarddrugsanddruguse.Othershavedemonstratedincreasesinknowledgeaboutdrugsortheconsequencesofusingdrugs.But,effortstodemonstratethatpreventionprogramscouldimpactonactualdrugusehavebeendisappointing.

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ResearchwiththeLifeSkillsTrainingProgramMorethanoneandahalfdecadesofresearchwiththeLSTprogramhaveconsistentlyshownthatparticipationintheprogramcancutdruguseinhalf.Thesereductions(relativetocontrols)inboththeprevalence(i.e.,proportionofpersonsinapopulationwhohavereportedsomeinvolvementinaparticularoffense)andincidence(i.e.,thenumberofoffenseswhichoccurinagivenpopulationduringaspecifiedtimeinterval)ofdrugusehaveprimarilybeenwithrespecttotobacco,alcohol,andmarijuanause.Thesestudieshavedemonstratedthatthispreventionapproachcanproducereductionsindrugusethatarelong-lastingandclinicallymeaningful.Forexample,long-termfollow-updataindicatethatreductionsindruguseproducedwithseventhgraderscanlastuptotheendofhighschool.EvaluationresearchhasdemonstratedthatthispreventionapproachiseffectivewithabroadrangeofstudentsincludingWhite,middle-classyouthandpoorinner-cityminority(AfricanAmericanandHispanic/Latino)youth.Ithasnotonlydemonstratedreductionsintheuseoftobacco,alcohol,ormarijuanauseofupto80percent,butevaluationstudiesshowthatitalsocanreducemoreseriousformsofdruginvolvementsuchastheweeklyuseofmultipledrugsorreductionsintheprevalenceofpack-a-daysmoking,heavydrinking,orepisodesofdrunkenness.

ResultsfromfourpublishedstudiestestingtheLSTprogramshowthatdruguseamongtheLSTstudentswasatleasthalfthatofthecontrolgroup.

TheinformationforthisfactsheetwasexcerptedfromBotvin,G.J.,Mihalic,S.F.,&Grotpeter,J.K.(1998).BlueprintsforViolencePrevention,BookFive:LifeSkillsTraining.Boulder,CO:CenterfortheStudyandPreventionofViolence.

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FAMILYNURSEPARTNERSHIPS(NURSE-FAMILYPARTNERSHIPSINTHEUSA)

ProgramSummaryFamilyNursePartnershipsorNurse-FamilyPartnershipsintheUSA(FormerlyPrenatalandInfancyHomeVisitationbyNurses),guidedbyastrongtheoreticalorientation,consistsofintensiveandcomprehensivehomevisitationbynursesduringawoman’spregnancyandthefirsttwoyearsafterbirthofthewoman’sfirstchild.Whiletheprimarymodeofservicedeliveryishomevisitation,theprogramdependsuponavarietyofotherhealthandhumanservicesinordertoachieveitspositiveeffects.Theprogramisdesignedtoservelow-income,at-riskpregnantwomenbearingtheirfirstchild.

ProgramContentNursehomevisitorsworkwithfamiliesintheirhomesduringpregnancyandthefirsttwoyearsofthechild’slife.Theprogramisdesignedtohelpwomenimprovetheirprenatalhealthandtheoutcomesofpregnancy;improvethecareprovidedtoinfantsandtoddlersinanefforttoimprovethechildren’shealthanddevelopment;andimprovewomen’sownpersonaldevelopment,givingparticularattentiontotheplanningoffuturepregnancies,women’seducationalachievement,andparents’participationintheworkforce.Typically,anursevisitorisassignedtoafamilyandworkswiththatfamilythroughthedurationoftheprogram.

ProgramOutcomesThisprogramhasbeentestedwithbothWhiteandAfricanAmericanfamiliesinruralandurbansettings.Nurse-visitedwomenandchildrenfaredbetterthanthoseassignedtocontrolgroupsineachoftheoutcomedomainsestablishedasgoalsfortheprogram.Ina15-yearfollow-upstudyofprimarilyWhitefamiliesinElmira,NewYork,findingsshowedthatlow-incomeandunmarriedwomenandtheirchildrenprovidedanursehomevisitorhad,incontrasttothoseinacomparisongroup:

■ 79%fewerverifiedreportsofchildabuseorneglect;■ 31%fewersubsequentbirths;■ anaverageofovertwoyears’greaterintervalbetweenthebirthoftheirfirst

andsecondchild;■ 30monthslessreceiptofAidtoFamilieswithDependentChildren;■ 44%fewermaternalbehavioralproblemsduetoalcoholanddrugabuse;■ 69%fewermaternalarrests;■ 60%fewerinstancesofrunningawayonthepartofthe15-year-oldchildren;■ 56%fewerarrestsonthepartofthe15-year-oldchildren;and■ 56%fewerdaysofalcoholconsumptiononthepartofthe15-year-oldchildren.

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ProgramCostsThecostoftheprogramwasrecoveredbythefirstchild’sfourthbirthday.Substantialsavingstogovernmentandsocietywerecalculatedoverthechildren’slifetimes.In1997,thetwo-and-a-half-yearprogramwasestimatedtocost$3,200peryearperfamilyduringthestart-upphase(thefirstthreeyearsofprogramoperation)and$2,800perfamilyperyearoncethenursesarecompletelytrainedandworkingatfullcapacity.Actualcostoftheprogramwillvarydependingprimarilyuponthesalariesoflocalcommunity-healthnurses.Communitieshaveusedavarietyoflocal,state,andfederalfundingsourcestosupporttheprogram,includingMedicaid,welfare-reform,maternalandchildhealth,andchildabusepreventiondollars.

ProgramBackgroundManyofthemostpervasive,intractable,andcostlyproblemsfacedbyyoungchildrenandparentsinoursocietytodayareaconsequenceofadversematernalhealth-relatedbehaviors(suchascigarettesmoking,drinking,anddruguse)duringpregnancy,dysfunctionalinfantcaregiving,andstressfulenvironmentalconditionsthatinterferewithparentalandfamilyfunctioning.Theseproblemsincludeinfantmortality,pretermdeliveryandlowbirthweight,childabuseandneglect,childhoodinjuries,youthviolence,closelyspacedpregnancy,andthwartedeconomicself-sufficiencyonthepartofparents.Standardindicesofchildhealthandwell-beingindicatethatmanychildreninoursocietyaresuffering.

■ NineinfantsoutofeverythousandintheUnitedStatesdiebeforetheirfirstbirthday.Asaresultofhighratesoflowbirthweight(lessthan2500gramsor5pounds8ounces),ourinfantmortalityrateisworsethan19othernations,inspiteofdramaticreductionsininfantmortalityinthelasttwodecadesduetoimprovementsinnewbornintensivecare.Lowbirthweightbabieswhosurviveare50percentmorelikelytousespecialeducationservicesoncetheyenterschoolthanarenormalbirthweightcontrols.

■ Over2.5millionchildrenwerereportedasbeingabusedorneglectedin1990,andoneinthreeofthevictimsofphysicalabusewereinfantslessthanoneyearofage.Between1,200and1,500childrendieeachyearasaresultofparentorcaregivermaltreatment.Notonlyismaltreatmentmorallyunacceptable,butthesocialconsequencesaresodevastatingthattheU.S.AdvisoryPanelonChildAbuseandNeglecthascalledchildmaltreatmentanationalemergency.

■ Childhoodinjuriesaretheleadingcauseofdeathamongchildrenagedonetofourteen.

■ Highratesofviolenceamongadolescents,bothasvictimsandperpetrators,threatenthesafetyandwell-beingofourneighborhoods.Amongyoungpeopleaged15-24,homicideisaleadingcauseofdeath,andforAfricanAmericansitisthenumberonecause.

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■ In1992,52percentofthemothersonAFDChadtheirfirstbirthasteens,costingthegovernmentapproximately$12.8billion.Rapidsuccessivepregnancyincreasesthelikelihoodofcontinuedwelfaredependenceandahostofassociatedproblems.

Evidenceindicatesthatasignificantportionoftheseproblemscanbetracedtoparentalbehavior—inparticular,towomen’shealth-relatedbehaviorsduringpregnancy,tothequalityofcarethatparentsprovidetotheirchildren,andtowomen’slifechoiceswithrespecttofamilyplanning,educationalachievement,andworkforceparticipation.WhiletheseproblemscutacrossallsegmentsofU.S.society,theyaremorecommonamongwomenwhobeginchildbearingaspoor,unmarriedadolescents.Low-income,single,adolescentmotherscanhavegoodpregnancyoutcomesandchildrenwhodowell,buttheircapacitytocareforthemselvesandfortheirchildrenisoftencompromisedbyhistoriesofmaltreatmentintheirownchildhood,psychologicalimmaturityordepression,stressfullivingconditions,andinadequatesocialsupport.Theseconditionscontributetothegreaterlikelihoodthatsociallydisadvantagedparentswillabusecigarettesandotherdrugsduringpregnancyandwillfailtoprovideadequatecarefortheirchildren,oftenwithdevastatingresults.

Womenwhosmokecigarettesanduseothersubstancesduringpregnancy,forexample,areatconsiderableriskforbearinglowbirthweightnewborns,andtheirchildrenareatheightenedriskforneurodevelopmentalimpairment.Evensubtledamagetothefetalbraincanunderminechildren’sintellectualfunctioningandcapacityforemotionalandbehavioralregulation.Parents’capacitiestoreadandrespondtotheirinfants’communicativesignalsformthebasisforchildren’ssenseofsecurityandtrustintheworldandtheirbeliefintheircapacitytoinfluencethatworld.Breachesofthattrusthavelong-termconsequences,especiallywhencaregivingdysfunctioniscombinedwithneurodevelopmentalimpairmentonthepartofthechild.

AlongitudinalstudyofalargeDanishsampleofchildrenandtheirfamiliesfoundthatchildrenwhoexperiencedthecombinationofbirthcomplicationsandparentalrejectioninthefirstyearoflifewereatsubstantiallyincreasedriskforviolentcriminalityatage18incomparisontochildrenwhoexperiencedonlybirthcomplicationsorparentalrejectionalone.Whileonly4.5percentofthesampleexperiencedbothbirthcomplicationsandparentalrejection,thatgroupaccountedfor18percentofallviolentcrimesamongthose18yearsofage.Parentalrejectionorbirthtraumabyitselfdidnotincreasetheriskforviolence.Whenriskfactorsaccumulate,theriskforadverseoutcomesincreases,ofteninsynergisticallyviciousways.

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Theproblemslistedhavebeenresistivetogovernmentinterventionoverthepastthirtyyears.However,scientificevidenceisaccumulatingthatitispossibletoimprovetheoutcomesofpregnancy,toimproveparents’abilitiestocarefortheirchildren,andtoreducewelfaredependencewithprogramsofprenatalandearlychildhoodhomevisitation,butitisnoteasy.Ouroptimismstandsincontrasttoearlierresearchonhomevisitation.Theearlierresearchwasdifficulttointerpretbecausetheprogramsstudiedwereoftennotdesignedtoaddresstheneedsofparentsinsensibleandpowerfulways,andtheresearchitselffrequentlylackedscientificrigor.

Theprogramofprenatalandinfancyhomevisitationbynursesdescribedhereisdistinguishedfromotherprogramsbyitsfirmfoundationinepidemiologyandtheory.Theprogramisbaseduponananalysisofproximalrisksfortheparticularoutcomesthatitisdesignedtoaffect(usuallyparentalbehaviorsorconditionsinthehomethatincreasethelikelihoodofadverseoutcomesonthepartofthemotherorchild).Italsoisfoundeduponthreeinterrelatedtheoreticalfoundations—self-efficacy,attachment,andhumanecologytheories.Eachofthesetheoriesaddressesdifferentaspectsofthedevelopmentalsystemthatcontributestoadversematernalandchildoutcomesinvulnerablefamilies.

TheoreticalRationale/ConceptualFrameworkTheprogramhasbeengroundedintheoriesofhumanecology(Bronfenbrenner,1979,1992),self-efficacy(Bandura,1977,1982),andhumanattachment(Bowlby,1969).Theearliestformulationsoftheprogramgavegreatestemphasistohumanecology,butastheprogramhasevolved,ithasbeengroundedmoreexplicitlyintheoriesofself-efficacyandhumanattachment.

TheoriginalformulationofthisprogramwasbasedinlargepartonBronfenbrenner’stheoryofhumanecology.Humanecologytheoryemphasizestheimportanceofsocialcontextsasinfluencesonhumandevelopment.Parents’careoftheirinfants,fromthisperspective,isinfluencedbycharacteristicsoftheirfamilies,socialnetworks,neighborhoods,communities,andcultures,andinterrelationsamongthesestructures.Bronfenbrenner’soriginaltheoreticalframeworkhasbeenelaboratedmorerecently(withgreaterattentiontoindividualinfluences)inhisperson-process-contextmodelofresearchonhumandevelopment.

Thepersonelementsofthemodelarereflectedintheprogramcomponentsthathavetodowithbehavioralandpsychologicalcharacteristicsoftheparentandchild.Intheformulationofthetheoreticalfoundationsoftheprogram,parents,andespeciallymothers,areconsideredbothdevelopingpersonsandtheprimaryfocusofthepreventiveintervention.Particularattentionisfocusedonparents’progressivemasteryoftheirrolesasparentsandasadultsresponsiblefortheirownhealthand

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economicself-sufficiency.Thisprogramemphasizesparentdevelopmentbecauseparents’behaviorconstitutesthemostpowerfulandpotentiallyalterableinfluenceonthedevelopingchild,particularlygivenparents’controlovertheirchildren’sprenatalenvironment,theirface-to-faceinteractionwiththeirchildrenpostnatally,andtheirinfluenceonthefamily’shomeenvironment.

Theconceptofprocessencompassesparents’interactionwiththeirenvironmentaswellastheintrapsychicchangesthatcharacterizetheirmasteryoftheirrolesasparentsandproviders.Threeaspectsofprocessemphasizedhererelatetoindividuals’functioning:(1)programprocesses(e.g.,thewaysinwhichthevisitorsworkwithparentstostrengthenparents’competencies);(2)processesthattakeplacewithinparents(i.e.,theinfluenceoftheirpsychologicalresources—developmentalhistories,mentalhealth,andcopingstyles—onbehavioraladaptation);and(3)parents’interactionwiththeirchildren,otherfamilymembers,friends,andhealthandhumanserviceproviders.Forthesakeofsimplicity,thediscussionoftheseprocesseshasbeenintegratedbelowintotheperson(parent)partofthemodel.

Thefocusonparentselaboratedhereisnotintendedtominimizetherolethatcontextualfactorssuchaseconomicconditions,culturalpatterns,racism,andsexismplayinshapingtheopportunitiesthatparentsareafforded.Mostofthosefeaturesoftheenvironment,however,areoutsideoftheinfluenceofpreventiveinterventionsprovidedthroughhealthandhumanservicesystems.Certaincontexts,nevertheless,areaffectedbyparents’adaptivecompetencies.Itisthesefeaturesoftheenvironmentthatthecurrentprogramattemptstoaffect,primarilybyenhancingparents’socialskills.Theaspectsofcontextthatwearemostconcernedabouthavetodowithinformalandformalsourcesofsupportforthefamily,characteristicsofcommunitiesthatcansupportorunderminethefunctioningoftheprogramandfamilies,theimpactofgoingtoschoolorworkingonfamilylife,aswellasculturalconditionsthatneedtobetakenintoconsiderationinthedesignandconductoftheprogram.

Oneofthecentralhypothesesofecologicaltheoryisthatthecapacityoftheparent-childrelationshiptofunctioneffectivelyasacontextfordevelopmentdependsontheexistenceandnatureofotherrelationshipsthattheparentmayhave.Theparent-childrelationshipisenhancedasacontextfordevelopmenttotheextentthateachoftheseotherrelationshipsinvolvesmutualpositivefeelingsandthattheotherpartiesaresupportiveofthedevelopmentalactivitiescarriedonintheparent-childrelationship.Conversely,thedevelopmentalpotentialoftheparent-childrelationshipisimpairedtotheextentthateachoftheotherrelationshipsinwhichtheparentisinvolvedconsistsofmutualantagonismorinterferencewiththedevelopmentalactivitiescarriedonintheparent-childrelationship.

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LimitationsofHumanEcologyTheory.Comparedtootherdevelopmentaltheories,Bronfenbrenner’sframeworkprovidesamoreextendedandelaboratedconceptionoftheenvironment.Theoriginalformulationofthetheory,however,tendedtotreattheimmediatesettingsinwhichchildrenandfamiliesfindthemselvesasshapedbyculturalandstructuralcharacteristicsofthesociety.Littleconsiderationwasgiventotherolethatadults(inparticularparents)playinselectingandshapingthesettingsinwhichtheyfindthemselves.Whilemanyinvestigatorstodayreasonthatthepersonalcharacteristicsthatinfluenceindividuals’selectionandshapingoftheircontextshavegeneticorigins,wehavechosentodeterminetheextenttowhichandthemeansbywhichhealthychoicesandadaptivebehaviorscanbepromoted.

Consequently,self-efficacyandattachmenttheorieswereintegratedintothemodeltoprovideabroaderconceptionoftheparentsettingrelationship.Theintegrationofthesetheoriesallowsforaconceptualizationofdevelopmentthatencompassestrulyreciprocalrelationshipsinwhichsettings,children,andotheradultsinfluenceparentalbehavior,andinwhichparentssimultaneouslyselectandshapetheirsettingsandinterpersonalrelationships.

Self-EfficacyTheorySelf-efficacytheoryprovidesausefulframeworkforpromotingwomen’shealth-relatedbehaviorduringpregnancy,careoftheirchildren,andpersonaldevelopment.AccordingtoBandura,differencesinmotivation,behavior,andpersistenceineffortstochangeawiderangeofsocialbehaviorsareafunctionofindividuals’beliefsabouttheconnectionbetweentheireffortsandtheirdesiredresults.Accordingtothisview,cognitiveprocessesplayacentralroleintheacquisitionandretentionofnewbehaviorpatterns.Inselfefficacytheory,Banduradistinguishesoutcomeexpectationsfromefficacyexpectations.Outcomeexpectationsareindividuals’estimatesthatagivenbehaviorwillleadtoagivenoutcome.Efficacyexpectationsareindividuals’beliefsthattheycansuccessfullycarryoutthebehaviorrequiredtoproducetheoutcome.Itisefficacyexpectationsthataffectboththeinitiationandpersistenceofcopingbehavior.Individuals’perceptionsofself-efficacycaninfluencetheirchoiceofactivitiesandsettings,andcandeterminehowmuchefforttheywillputforthinthefaceofobstacles.

LimitationsofSelf-EfficacyTheory.Whileself-efficacytheoryprovidespowerfulinsightsintohumanmotivationandbehavior,itislimitedinseveralrespects.Thefirstlimitationisthatitisprimarilyacognitive-behavioraltheory.Itattendstotheemotionallifeofthemotherandotherfamilymembersonlythroughtheimpactofbehavioronwomen’sbeliefsorexpectations,whichinturnaffectemotions.Manypeoplehaveexperiencedmultipleadversitiesintheformofoverlyharshparenting,rejection,orneglectthatoftencontributetoasenseofworthlessness,depression,

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andcynicismaboutrelationships.Self-efficacygivesinadequateattentiontomethodsofhelpingparentscopewiththesefeaturesoftheirpersonalhistoryortheimpactofthoseearlyexperiencesontheircareoftheirchildren.Wehaveaugmentedthetheoreticalunderpinningsoftheprogramregardingthesesocialandemotionalissueswithattachmenttheory(discussedbelow).

Thesecondlimitationisthatself-efficacyattendstoenvironmentalinfluencesinacursoryway.Peoplecangiveupbecausetheydonotbelievethattheycandowhatisrequired,buttheyalsocangiveupbecausetheyexpectthattheireffortswillmeetwithpunitiveness,resistance,orunresponsiveness.WhileBanduraacknowledgesthatadversityandintractableenvironmentalconditionsareimportantfactorsinthedevelopmentofindividuals’senseoffutility,thestructureofthoseenvironmentalforcesisnotthesubjectofBandura’stheory.Inotherwords,individuals’feelingsofhelplessnessandfutilityarenotsimplyintra-psychicphenomena,butareconnectedtoenvironmentalcontextsthatprovidelimitedopportunitiesandthatfailtonurtureindividuals’growthandwell-being.Thestructureofthoseenvironmentalinfluencesistheprimarysubjectofhumanecologytheory,discussedabove.

AttachmentTheoryHistorically,thisprogramowesmuchtoBowlby’stheoryofattachment.Attachmenttheorypositsthathumanbeings(andotherprimates)haveevolvedarepertoireofbehaviorsthatpromoteinteractionbetweencaregiversandtheirinfants(suchascrying,clinging,smiling,signaling),andthatthesebehaviorstendtokeepspecificcaregiversinproximitytodefenselessyoungsters,thuspromotingtheirsurvival,especiallyinemergencies.Humans(aswellasmanyotherspecies)arebiologicallypredisposedtoseekproximitytospecificcaregiversundertimesofstress,illness,orfatigueinordertopromotesurvival.Thisorganisationofbehaviordirectedtowardthecaregiverisattachment.

Inrecentyears,agrowingbodyofevidenceindicatesthatcaregivers’levelsofresponsivitytotheirchildrencanbetracedtocaregivers’ownchildrearinghistoriesandattachment-relatedexperiences.Caregivers’attachment-relatedexperiencesarethoughttobeencodedin“internalworkingmodels”ofselfandothersthatcreatestylesofemotionalcommunicationandrelationshipsthateitherbuffertheindividualintimesofstressorthatleadtomaladaptivepatternsofaffectregulationandcreatefeelingsofworthlessness.Differencesininternalworkingmodels,accordingtoattachmenttheorists,haveenormousimplicationsformothers’capacitiesfordevelopingsensitiveandresponsiverelationships,especiallywiththeirownchildren.

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LimitationsofAttachmentTheoryAttachmenttheoryprovidesarichsetofinsightsintotheoriginsofdysfunctionalcare-givingandpossiblepreventiveinterventionsfocusedonparent-visitorandparent-childrelationships.Itgivesscantattentiontotherolethatindividualdifferencesininfantsmayplayasindependentinfluencesonparentalbehavior,anditprovidesinadequateattentiontoissuesofparentalmotivationforchangeincare-giving.Moreover,itminimizestheimportanceofthecurrentsocialandmaterialenvironmentinwhichthefamilyisfunctioningasinfluencesonparents’capacitiestocarefortheirchildren.Formoresystematictreatmentsoftheseissues,weturnedtoself-efficacyandhumanecologytheories(discussedabove).

SummaryoftheRoleofTheoryandEpidemiologyinProgramDesignTheprogramanditsspecificinterventionstrategieshavebeenbuiltupon:

■ theoriesabouthumandevelopmentandchange,and■ asolidunderstandingoftheriskfactorsforparticularnegativeoutcomesand

howtoreducethoserisksbypromotingadaptivebehavior.

BriefDescriptionofInterventionTheprogramofhomevisitationbeginsduringpregnancyandcontinuesthroughthechild’ssecondbirthday.Eachfamilyisassignedanursewhovisitsfamiliesaboutonceeveryotherweekduringpregnancyandthefirsttwoyearsofthechild’slife.Totheextentpossible,programsshouldkeepthesamenurseassignedtoafamilyfortheentiretimetheyparticipateintheprogram.Programprocessstudieshaveshownthatprogrameffectivenesstendstodeclinewhenfamiliesareservedbymorethanonenurseoverthecourseoftheirparticipation.

Thenursesuseprogramprotocolsthataredesignedtoaccomplishthreeoverridinggoals:(1)theimprovementofpregnancyoutcomes;(2)theimprovementofthechild’shealthanddevelopment;and(3)theimprovementofthemothers’ownpersonaldevelopment.Inthehomevisits,thenursespromotethreeaspectsofmaternalfunctioning:(a)health-relatedbehaviorsduringpregnancyandtheearlyyearsofthechild’slife;(b)thecareparentsprovidetotheirchildren;and(c)parents’familyplanning,educationalachievement,andparticipationintheworkforce.Intheserviceofthesethreegoals,thenurseslinkfamilieswithneededhealthandhumanservicesandinvolveotherfamilymembersandfriendsinthepregnancy,birth,andearlycareofthechild.

Thenursesusedetailedassessments,record-keepingforms,andprotocolstoguidetheirworkwithfamiliesbutadaptthecontentoftheirhomevisitstotheindividualneedsofeachfamily.Theyprovideacomprehensiveeducationalprogramdesignedtopromoteparents’andotherfamilymembers’effectivephysicalandemotional

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careoftheirchildren.Thenursesalsohelpwomenclarifytheirgoalsanddevelopproblem-solvingskillstoenablethemtocopewiththechallengesofcompletingtheireducation,findingwork,andplanningfuturepregnancies.Developingacloseworkingrelationshipwiththemotherandherfamily,thenurseshelpmothersidentifysmallachievableobjectivesthatcanbeaccomplishedbetweenvisitsthat,ifmet,willbuildmothers’confidenceandmotivationtomanagethedemandsofcare-givingandbecomeeconomicallyself-sufficient.

Theprogramfocusesonspecificparentalbehaviorsandmodifiableenvironmentalconditionsthatareassociatedwithadverseoutcomesineachofthedomainsidentifiedasprogramgoals.Theprotocolsandrecordkeepingsystemaredesignedtoreinforcehomevisitors’focusonprogramgoalsandtheoreticalfoundationsoftheprogram.

Thenursesarescheduledtovisitfamiliesonceaweekforthefirstmonthafterregistrationandtheneveryotherweekthroughdelivery.Afterdeliverythenursesarescheduledtovisitonceaweekforthefirstsixweeksofthebaby’slifeandtheneveryotherweekuntilthe21stmonthpostpartum.From21to24monthspostpartum,thenursesvisitonceamonth.Inthesevisits,whichtypicallylastfrom60-90minutes,thenursesworktoachievethegoalsandobjectivesoutlinedabove,employingclinicalinterventionsthataregroundedintheoriesofhumanecology,attachment,andself-efficacy.Itshouldbenoted,however,thatsomemothersareincrisesthatinterferewiththeirconsistentlykeepingscheduledappointments.Althoughthenursesmakeeveryefforttofollowthespecifiedscheduleofvisits,theyareallowedtovisitmorefrequentlywhenfamiliesexhibitcrisesthatwouldwarrantmoreintensivesupport.Inaddition,althoughtherearespecifieddomainsofprogramcontentthataredevelopmentallyorganizedandexpectedtobecoveredduringparticularperiods,familiesexhibitconsiderablevariationintheirexpressedneeds.Thisleadstosubstantialindividualvariationintheamountoftimethatmaybespentonparticularprogramcontentareas.Allofthisleadstovariationintheamountandcontentoftheprogramexperiencedbyanyonefamily.Theprogramneverthelessadherestoacoresetofprogramgoals,content,andmethods.

EvidenceofProgramEffectivenessForlow-incomewomenandtheirchildren,theprogramhasbeensuccessfulin:

■ improvingwomen’sprenatalhealth-relatedbehaviors(especiallyreducingcigarettesmokingandimprovingdiet);

■ reducingpregnancycomplications,suchashypertensivedisordersandkidneyinfections;

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■ reducingharmtochildren,asreflectedinfewercasesofchildabuseandneglectandinjuriestochildrenrevealedintheirmedicalrecords;

■ improvingwomen’sownpersonaldevelopment,indicatedbyreductionsintheratesofsubsequentpregnancy,anincreaseinspacingbetweenfirstandsecondbornchildren,areductioninwelfaredependence,andreductionsinbehavioralproblemsduetosubstanceabuseandincriminalbehavioronthepartofmotherswhowereunmarriedandfromlow-incomehouseholdsatregistrationduringpregnancy;and

■ reducingcriminalandantisocialbehavioronthepartofthe15-yearoldchildrenasindicatedbyfewerarrests,convictions/violationsofprobation,anddaysofconsumingalcohol.

Thecostoftheprogram,fromthestandpointofgovernmentspending,isrecoveredbythetimethechildrenreachfouryearsofage,andthecostsavingstogovernmentandsocietyexceedthecostoftheprogrambyafactorofatleast4:1overthechild’slifetime.

IntheUKFamilyNursePartnershipstendstobedeliveredtoyoungparentse.g.uptoage20oruptoage24.


Olds,D.,Hill,P.,Mihalic,S.,&O’Brien,R.(1998).BlueprintsforViolencePrevention,BookSeven:PrenatalandInfancyHomeVisitationbyNurses.Boulder,CO:CenterfortheStudyandPreventionofViolence.

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PROMOTINGALTERNATIVETHINKINGSTRATEGIES(PATHS)

ProgramSummaryThePATHS(PromotingAlternativeTHinkingStrategies)Curriculumisacomprehensiveprogramforpromotingemotionalandsocialcompetenciesandreducingaggressionandbehaviorproblemsinelementaryschool-agedchildrenwhilesimultaneouslyenhancingtheeducationalprocessintheclassroom.Thisinnovativecurriculumisdesignedtobeusedbyeducatorsandcounselorsinamulti-year,universalpreventionmodel.Althoughprimarilyfocusedontheschoolandclassroomsettings,informationandactivitiesarealsoincludedforusewithparents.

ProgramTargetsThePATHSCurriculumwasdevelopedforuseintheclassroomsettingwithallelementaryschoolaged-children.PATHShasbeenfield-testedandresearchedwithchildreninregulareducationclassroomsettings,aswellaswithavarietyofspecialneedsstudents(deaf,hearing-impaired,learningdisabled,emotionallydisturbed,mildlymentallydelayed,andgifted).IdeallyitshouldbeinitiatedattheentrancetoschoolingandcontinuethroughGrade5.

ProgramContentThePATHSCurriculum,taughtthreetimesperweekforaminimumof20-30minutesperday,providesteacherswithsystematic,developmentally-basedlessons,materials,andinstructionsforteachingtheirstudentsemotionalliteracy,self-control,socialcompetence,positivepeerrelations,andinterpersonalproblem-solvingskills.Akeyobjectiveofpromotingthesedevelopmentalskillsistopreventorreducebehavioralandemotionalproblems.PATHSlessonsincludeinstructioninidentifyingandlabelingfeelings,expressingfeelings,assessingtheintensityoffeelings,managingfeelings,understandingthedifferencebetweenfeelingsandbehaviors,delayinggratification,controllingimpulses,reducingstress,self-talk,readingandinterpretingsocialcues,understandingtheperspectivesofothers,usingstepsforproblem-solvinganddecision-making,havingapositiveattitudetowardlife,self-awareness,nonverbalcommunicationskills,andverbalcommunicationskills.Teachersreceivetraininginatwo-tothree-dayworkshopandinbi-weeklymeetingswiththecurriculumconsultant.

ProgramOutcomesThePATHSCurriculumhasbeenshowntoimproveprotectivefactorsandreducebehavioralriskfactors.Evaluationshavedemonstratedsignificantimprovementsforprogramyouth(regulareducation,specialneeds,anddeaf)comparedtocontrolyouthinthefollowingareas:

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■ Improvedself-control,■ Improvedunderstandingandrecognitionofemotions,■ Increasedabilitytotoleratefrustration,■ Useofmoreeffectiveconflict-resolutionstrategies,■ Improvedthinkingandplanningskills,■ Decreasedanxiety/depressivesymptoms(teacherreportofspecialneeds

students),■ Decreasedconductproblems(teacherreportofspecialneedsstudents),■ Decreasedsymptomsofsadnessanddepression(childreport–specialneeds),

and■ Decreasedreportofconductproblems,includingaggression(childreport).

ProgramCostsProgramcostsoverathree-yearperiodwouldrangefrom$15/student/yearto$45/student/year.Thehighercostwouldincludehiringanon-sitecoordinator,thelowercostwouldincluderedeployingcurrentstaff.

ProgramBackgroundThePATHS(PromotingAlternativeTHinkingStrategies)Curriculumwasdevelopedtofilltheneedforacomprehensive,developmentally-basedcurriculumintendedtopromotesocialandemotionalcompetenceandpreventorreducebehaviorandemotionalproblems.Fromitsinception,thegoalofPATHSwasfocusedonpreventionthroughthedevelopmentofessentialdevelopmentalskillsinemotionalliteracy,positivepeerrelations,andproblem-solving.TheCurriculum(Kusché&Greenberg,1994)isdesignedtobetaughtbyelementaryschoolteachersfromgradeKthroughgrade5.

Twodecadesofpriorresearchhadindicatedanincreasingemphasisontheneedforuniversal,school-basedcurriculaforthepurposesofbothpromotingemotionalcompetenceanddecreasingriskfactorsrelatedtolatermaladjustment.However,althoughpreviousresearchhassuggestedthatsuchapproachesmightbeespeciallyeffectiveduringtheelementaryschoolyears,mostevaluationshadbeenrestrictedinscopeand/orhadinvolvedprogramswithconsiderablelimitations(e.g.,narrowdevelopmentalfocus,shortduration,andunreliableandinvalidoutcomemeasures).Extensivefocusonteachingemotionalcompetency,understanding,andawarenesswasnotablylacking,andcomprehensiveevaluationsandinclusiveprogramswererare.Theseshortcomingsweresurprising,giventhewiderangeofcurriculautilizedinelementaryeducationthatwereintendedtopromotesocialcompetenceandpreventdisorder.Nevertheless,researchstronglysuggestedthatacomprehensivepreventionprogramintheclassroomsettinghadthepotentialtoprovidemuchneededassistanceforbothnormally-adjustedandbehaviorallyat-riskstudents.

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Inaddition,webelievedthattherapidandcomplexculturalchangesofthepastfewdecades,aswellasthosepredictedfortheforeseeablefuture,madeemotionalandsocialcompetencycrucialrequirementsforadaptiveandsuccessfulfunctioningofchildrenandfortheircontinuingadaptationasadolescentsandadults.Althoughsocialandemotionalcompetencehadneverbeenconsideredanecessarycomponentofeducationinthepast,wefeltthatithadbecomeascriticalforthebasicknowledgerepertoireofallchildrenasreading,writing,andarithmetic.Teachersacknowledgedthattheyhadlittlebackgroundorestablishedstrategiestodealwithemotionalandsocialcompetency,sowefeltthatitwasnecessarytoprovidedetailedlessons,aswellasmaterialsandinstruction.

Aswithmanyofthemorerecentschool-basedpreventiveinterventions,PATHSwasdesignedtobetaughtbyregularclassroomteachers(initiallywithsupportfromprojectstaff)asanintegratedcomponentoftheregularyear-longcurriculum.However,itisimportanttoensurethatchildrengeneralize(i.e.,applytheskillstonewcontexts)theuseofPATHSskillstotheremainderofthedayandtoothercontexts.Thus,generalizationactivitiesandstrategieswereincorporatedtobeusedin(andoutsideof)theclassroomthroughouteachschoolday,andmaterialswereincludedforusewithparents.

Morerecentliteraturereviewshaveindicatedthatsuccessfulprogramshavethefollowingcharacteristics:(a)utilizingaprogramoflongerduration,(b)synthesizinganumberofsuccessfulapproaches,(c)incorporatingadevelopmentalmodel,(d)providinggreaterfocusontheroleofemotionsandemotionaldevelopment,(e)providingincreasedemphasisongeneralizationtechniques,(f)providingongoingtrainingandsupportforimplementation,and(g)utilizingmultiplemeasuresandfollow-upsforassessingprogrameffectiveness.

Allsevenoftheseunder-emphasizedbutcriticalfactorshavebeenincorporatedintothePATHScurriculum.Furthermore,asPATHShasbeenutilizedwithdifferentcohortsandpopulationsoverthepast15years,multiplefield-testswithextensivefeedbackfromteachershasledtoexpansionandimprovementinPATHSovertime.

TheoreticalRationale/ConceptualFrameworkThePATHSprevention-interventionprogramisbasedonfiveconceptualmodels.Thefirst,theABCD(Affective-Behavioral-Cognitive-Dynamic)ModelofDevelopmentfocusesonthepromotionofoptimaldevelopmentalgrowthforeachindividual.Thesecondmodelincorporatesaneco-behavioralsystemsorientationandemphasizesthemannerinwhichtheteacherusesthecurriculummodelandgeneralizestheskillstobuildahealthyclassroomatmosphere(i.e.,onethatsupportsthechildren’suseandinternalizationofthematerialtheyhavebeentaught).Thethirdmodelinvolvesthedomainsofneurobiologyandbrain

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structuralization/organization,whilethefourthparadigminvolvespsychodynamiceducation(derivedfromDevelopmentalPsychodynamicTheory).Finally,thefifthmodelincludespsychologicalissuesrelatedtoemotionalawareness,orasitismorepopularlylabeled,emotionalintelligence.

TheABCDModelTheABCDmodelincorporatesaspectsofdiversetheoriesofhumandevelopmentincludingpsychodynamicdevelopmentaltheory,developmentalsocialcognition,cognitivedevelopmentaltheory,cognitivesocial-learningtheory,andattachmenttheory.TheABCDmodelplacesprimaryimportanceonthedevelopmentalintegrationofaffect(i.e.,emotion,feeling,mood)andemotionlanguage,behavior,andcognitiveunderstandingtopromotesocialandemotionalcompetence.Abasicpremiseisthatachild’scoping,asreflectedinhisorherbehaviorandinternalregulation,isafunctionofemotionalawareness,affective-cognitivecontrol,andsocial-cognitiveunderstanding.ImplicitintheABCDmodelistheideathatduringthematurationalprocess,emotionaldevelopmentprecedesmostformsofcognition.Thatis,youngchildrenexperienceemotionsandreactonanemotionallevellongbeforetheycanverbalizetheirexperiences.Inearlylife,affectivedevelopmentisanimportantprecursorofotherwaysofthinkingandlaterneedstobeintegratedwithcognitiveandlinguisticabilities,whichareslowertodevelop.Table1presentsasummaryofstagesintheABCDModel(SeeGreenberg&Kusché,1993forelaboration).

Duringthefirstthreeyearsoflife,theentirerepertoireofemotionalsignalsdevelops,andthesesignals/displaysaresubsequentlyusedthroughouttherestofanindividual’slifetime.Thus,bythetimechildrenarebeginningtoutilizelanguagefluentlytoexpressinternalstatesofbeing(e.g.,feelingsad,happy,jealous),mostoftheiremotionalresponseshavealreadybecomehabitual.

Bytheendofthepreschoolyears,mostchildrenhavebecomeskilledinbothshowingandinterpretingemotionaldisplays,althoughthereareconsiderableindividualdifferencesinchildren’semotionalprofiles.Thechildalsobeginstodemonstrateaffectiveperspective-takingskills(i.e.,theabilitytodifferentiatetheemotions,needs,anddesiresofdifferentpeopleinaparticularcontext).Thepreschoolergraduallyfindsnewwaystocopewithunpleasantemotionsanddiscoversthatinternallyexperiencedaffectscanbedirectlysharedwithothersthroughverbalmeans.Furthermore,thechildbeginstoregulateinternalaffectivestatesthroughverbalself-regulation,acriticaldevelopmentalachievement.Anexampleofthisabilityiswhenapreschoolerisabletotellsomeoneheisangryinsteadofshowingaggressiontowardsapeerorobject.

Betweentheagesof5and7,childrenundergoamajordevelopmental

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transformationthatgenerallyincludesincreasesincognitiveprocessingskills,aswellaschangesinbrainsizeandfunction.Thistransitionandtheaccompanyingalterationsallowchildrentoundertakemajorchangesinresponsibilities,independence,andsocialroles.

Duringtheelementaryschoolyears,furtherdevelopmentalintegrationsoccurbetweenaffect,behavior,andcognition/language.Thisintegrationisofcrucialimportanceinachievingsociallycompetentactionandhealthypeerrelations.Forexample,intheearlyelementaryyearswhenachildhasbeenrebuffedwhenattemptingtoenteragamewithpeers,shemightwalkaway,calmdown,assesshowbothsheandtheotherkidsfeel,andthinkofanotherstrategytoenterthegame,orthinkofsomethingelsetodoorsomeoneelsewithwhomshecanplay.

Althoughresearchhasdemonstratedthelinkagebetweendeficitsinemotionaldevelopmentandpsychopathology,surprisinglylittleattentionhasbeenpaidtothecrucialroleofemotionaldevelopmentinmodelsofpreventiveintervention.Takingthisfactorintoaccount,thePATHSCurriculummodelsynthesizesthedomainsofself-control,emotionalawarenessandunderstanding,andsocialproblem-solvingtoincreasesocialandemotionalcompetence.

Table 1 ABCDModel(Affective-Behavioral-Cognitive-Developmental)

StagesofDevelopmentalIntegration

1.Infancy(Birthto18months)

Emotion=CommunicationArousalandDesire=Behavior

2.Toddlerhood(18monthsto36months)

LanguageSupplementsEmotion=CommunicationVeryInitialDevelopmentofEmotionalLabelingArousalandDesire=Behavior

3.PreschoolYears(3to6years)

LanguageDevelopsPowerfulRoleinCommunicationChildcanRecognize/LabelBasicEmotionsArousalandDesire>SymbolicMediation>BehaviorDevelopmentofRole-takingAbilitiesBeginningofReflectiveSocialPlanningProblem-Solving(GenerationofAlternativePlansforBehavior)

4.SchoolYears(6to12-13years)

ThinkinginLanguagehasbecomeHabitualIncreasingAbilitytoReflectonandPlanSequencesofActionDevelopingAbilitytoConsiderMultipleConsequencesofActionIncreasingAbilitytoTakeMultiplePerspectivesonaSituation

5.Adolescence UtilizeLanguageintheServiceofHypotheticalThoughtAbilitytoSimultaneouslyConsiderMultiplePerspectives

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TheEco-BehavioralSystemsModelThesecondconceptualmodelincorporatesaneco-behavioralsystemsorientationandexamineslearningprimarilyatthelevelofsystemschange.School-basedprogramsthatfocusindependentlyonthechildorenvironmentarenotaseffectiveasthosethatsimultaneouslyeducatethechildandinstillpositivechangesintheenvironment.Trainingprogramsmayappropriatelybeconsideredperson-centeredwhenskillsaretaughtintheabsenceofcreatingenvironmentalsupportsforcontinuedskillapplicationindailyinteractions.Incontrast,ecologicallyorientedprogramsemphasizenotonlytheteachingofskills,butalsothecreationofmeaningfulreal-lifeopportunitiestouseskillsandtheestablishmentofstructurestoprovidereinforcementforeffectiveskillapplication.Thus,althoughacentralgoalofPATHSistopromotethedevelopmentalskillsofeachchildbyprovidinglearningthatintegratesaffect,cognition,andbehavior,acriticalingredientforsuccessisthedevelopmentofahealthyclassroomandschoolenvironment.

Fromthisperspective,thesuccessofskillstrainingprogramsmaydependlargelyontheirattentiontoencouragingandsupportingsocializationpatternsandsupportsintheinterventionsetting.Forexample,ecologicallyorientedproblem-solvingprogramstrytointroduceacommonsocialinformationprocessingframeworkthatchildrenandteacherscanusetocommunicatemoreeffectivelyaboutproblemsituations.Inotherwords,theytrytochangenotonlythechild’sbehavior,butalsotheteacher’sbehavior,therelationshipbetweentheteacherandchild,andclassroomandschool-levelresourcesandprocedurestosupportadaptiveproblem-solvingefforts,assumingthattheinteractionsaredysfunctionalorineffective.

Thegeneralizationprocedures,extensiveteachertraining,andfocusonsomelevelofparentparticipationusedinPATHShavethegoalofcombiningclassroominstructionwitheffortstocreateenvironmentalsupportandreinforcementfrompeers,familymembers,schoolpersonnelhealthprofessionals,andotherconcernedcommunitymembers.Further,trainingemphasizesthemannerinwhichtheteacherusesthecurriculummodelandgeneralizestheskillstobuildahealthyclassroomatmosphere(i.e.,onethatsupportsthechildren’suseandinternalizationofthematerialtheyhavebeentaught).

NeurobiologyandBrainStructuralization/OrganizationWhendesigningPATHS,wepaidspecialattentiontodevelopmentalmodelsofbrainorganization.Twoofthemostrelevantconceptsweincorporatedinvolve“vertical”controland“horizontal”communication(Kusché,1984).

“Vertical”controlreferstohigher-orderprocessingandregulationofemotionandactionsbythefrontallobesoverthelimbicsystemandsensory-motorareas.Whenadultsfirstexperienceemotionalinformation,itisrapidlyperceivedandprocessed

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inthelimbicsysteminthemiddlepartofthebrain.Thisinitialinformationisthentransmittedtothefrontallobesintheneocortexforfurtherprocessingandinterpretation,and,subsequently,thefrontallobescantransmitmessagesbacktothelimbicsystemtomodifyemotionsignalsandtothesensory-motorcortextoinfluencepotentialactions.

Forexample,ifyousawacarcomingtowardsyouandyoustartledandjumpedtothesideoftheroad,allofthisrapidprocessingwouldhaveoccurredprimarilyinthelimbicsystemwithoutanytrueconsciousawarenessonyourpart.Afterwards,however,youwouldtakeinandprocessfurtherinformationatacorticallevel(e.g.,thethought,“Thatcaralmosthitme!”;thecolorofthecar;thelicenseplatenumber,etc.).Inadditiontotheinitialfear,youwouldprobablystarttofeelangry,aswellasrelieved,andyoumightdecidetoreporttheincidenttothepolice.

Rapidprimaryprocessingissometimescrucialforsurvival,asinthiscase,butsecondaryprocessinginthefrontalcortexisimportantbecauseitallowsustointegratedatainvolvingemotionswithknowledge-basedinformation,which,inturn,assistswithmakingappropriateplansforfurtheraction.

Earlyindevelopment(i.e.,bythetimeoftoddlerhood),therearefewinterconnectionsbetweenthelimbicsystemandthefrontallobes;thus,duringthe“terrible-twos,”childrenfrequentlyhit,bite,orkick“automatically”whentheyfeelangry.Aschildrenmature,however,increasingneuronalinterconnectionsevolvebetweenthefrontallobesandthelimbicsystem.Thisisespeciallyimportantwithregardtothedevelopmentofselfcontrol,becausethefrontalcortexbecomesincreasinglyabletoregulateimpulsesfromthelimbicareasandmodifypotentialactions.Betweentheagesof5and7,amajorshiftoccursinwhichnetworksinthefrontalareasachievesignificantdominancewithregardtoexertingemotionalself-regulationandbehavioralself-control.

However,thesedevelopmentalmilestonesdonotautomaticallyunfold,butratherareheavilyinfluencedbyenvironmentalinputthroughoutearlychildhood.Moreover,ifthesenetworksdonotdevelopinanoptimalmanner,childrenwillnothavetheneuronalstructurenecessarytocontroltheiractionsinresponsetostrongemotionalsignals.

Thus,inordertopromotethedevelopmentofexecutiveorverticalcontrolwithPATHS,weteachchildrentopracticeconsciousstrategiesforself-control,includingself-talk(i.e.,verbalmediationandtheControlSignalsPoster).Foryoungerchildrenandthosewitheitherdelayedlanguageordifficultiesinbehavioralandemotionalcontrol,weutilizethe“TurtleTechnique,”whichincludesamotor-inhibitingresponseinadditiontoself-talk.

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“Horizontal”communicationreferstoaphenomenonthatresultsfromtheasymmetryofinformationprocessinginthetwohalvesoftheneocortex(theoutermostandevolutionarilynewerpartofthebrain).

Thelefthemisphereisresponsibleforprocessingreceptiveandexpressivelanguageaswellasexpressingpositiveaffect.TherighthemisphereisspecializedforprocessingbothcomfortableanduncomfortablereceptiveaffectanduncomfortableexpressiveaffectinthemajorityofEnglish-speakingadults,theonlyculturalgrouponwhichresearchisavailable(Bryden&Ley,1983).

Nonlinguisticinformation(suchasemotionalsignals)isoftenprocessedwithoutawareness(preconsciousprocessing)unlessweverbally“think”aboutit.Toverballylabelouremotionalexperiences,andthusbecomeconsciouslyawareofthem,thisinformationmustbetransmittedtothelefthemisphere.However,theleftandrighthemispherescancommunicatewithoneanotheronlyviathecorpuscallosum,a“bridge”thathorizontallyconnectsthetwosidesofthebrain.Therefore,inordertobetrulyawareofouremotionalexperiences,wemustutilizeboththerightandlefthemispheres.Thelanguageareasontheleftsideofthebraincanalsomodifyandinfluenceaffectiveprocessingintheright(Davidson,1998;Sutton&Davidson,1997).

Aninterestingsituationoccursif,forsomereason,emotioninformationdoesnotreachthelefthemisphere(e.g.,anadequateneuralnetworkhasneverdevelopedorinterconnectionsareblockedfromintercommunication).Whenthisoccurs,anindividualwillexperienceemotion,butwillnotbeawareofhavingdoneso.Thus,otherpeoplecanbeawareofhowthepersonfeels(i.e.,byobservingfacialcues),buttheindividualwillnotbeawareofhavingexperiencedthefeelings.Afrequentillustrationofthisphenomenonoccurswhenateacherobservesachildwhoisclearlyfeelingangry,butthatchildtrulyhasnoconsciousawarenessofsuchanemotion(“Iamnotangry;Ifeelfine”).

Developmentofthecorpuscallosumisrelativelyslow,sothatitisonlywithmaturationthatoptimumhemisphericcommunicationispossible.Aswithverticalneuralnetworks,thewayinwhichinterhemisphericcommunicationoccursdependsheavilyonenvironmentalinputduringdevelopment.

Basedonthistheoryof“horizontal”communicationandcontrol,wehypothesizedthatverbalidentificationandlabeling,especiallyofuncomfortablefeelings,wouldpowerfullyassistwithmanagingthesefeelings,controllingbehavior,andimprovinghemisphericintegration.Thus,westresstheuseofFeelingFacecardsthatincludeboththefacialdrawingofeachaffect(recognitionofwhichismediatedbytherighthemisphere)anditsprintedlabel(whichismediatedbytheleft).In

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addition,wealsoutilizeacolor-codeddifferentiationofcomfortable(yellow)versusuncomfortable(blue)feelings.Inaddition,encouragingchildrentotalkaboutemotionalexperiences(bothatthetimetheyareoccurringandinrecollection)furtherstrengthensneuralintegration.

Insummary,ourknowledgeoftheneurobiologicaldevelopmentofthebrainwasheavilyinfluentialinthedevelopmentofPATHS.Researchstronglysuggeststhatlearningexperiencesinthecontextofmeaningfulrelationshipsduringchildhoodinfluencethedevelopmentofneuralnetworksbetweendifferentareasofthebrain,whichinturnaffectself-controlandemotionalawareness.Thus,weincorporatedstrategiesinPATHStooptimizethenatureandqualityofteacher-childandpeer-peerinteractionsthatarelikelytoimpactbraindevelopmentaswellaslearning(Greenberg&Snell,1997).Optimumdevelopmentofboth“vertical”and“horizontal”communicationandcontrolduringchildhoodshouldpromotebetteradaptationinbothcurrentandlaterlife.

PsychodynamicEducationTheapplicationofpsychoanalytictheorytotheeducationofchildrenhasonlyrecentlyreceivedsignificantattention.Psychodynamiceducationisintendedtoenhancedevelopmentalgrowth,promotementalhealth,andpreventemotionaldistress,butitisnottreatment.Inthisregard,teachersarenottherapistsandarenotexpectedtoactassuch.However,teachersarepowerfulrolemodels(individualswithwhomchildrencanidentifyinapositivemanner),andtheinformationtheyimpartisoftengiventhestatusofabsolutetruth(i.e.,omniscience),especiallyduringtheelementaryschool-ageyears.Whenteachersexpressaninterestinchildren’sfeelingsandemotionalexperiencesorshowrespectforchildren’sopinions,theirstudentsareimpactedinaprofoundmanner.Astheteacher-studentrelationshipsgrowincreasinglymorepositiveandenriched,learningisenhanced.

Psychodynamiceducationisderivedfromadevelopmentaltheoryandaimstocoordinatesocial,emotional,andcognitivegrowth.Teachersareencouragedtoutilizeactualclassroomexperiencesandusechildren’screative,imaginalprocesses.Studentscanthendevelopahealthysenseofself-esteemfromobservingthepositivereactionsofotherstowardsthem,notbecausetheyhavebeenencouragedtoparrotsimplisticaffirmations.Further,teachersplayacrucialrolebyprovidingclarificationsandexplanationsofemotionsandsituations.Animportantwayinwhichpsychodynamiceducationdiffersfromothermodelsisitsemphasisoninternalization,theprocessofhealthydevelopmentofconscience,or“takingownership”andself-responsibilityforone’sactions.

Bypromotingthedevelopmentofinternalself-controlandself-motivationalongwithhealthystandardsforbehavior,childrendevelopanoptimalsenseofautonomy

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anddecision-makingwhilealsoconsideringtheneedsandfeelingsofothers.Forexample,studentscontemplateanddiscusstheconsequencesofhavinggoodvs.badmannersandevaluatewhygoodmannersareimportant(e.g.,thewayweactaffectshowotherpeoplefeel),ratherthansimplybeingtaughtalistofgoodmannersthattheyaresupposedtouse.Inthisway,thechildrencometo“own”theconceptsasbelongingtothemselves(i.e.,theyinternalizethem);asaresult,theyvoluntarilychoosetousegoodmannersbecausetheybelieveitistherightthingtodo.

Insummary,someofthelong-rangegoalsofpsychodynamiceducationareforeachchildtodevelopakindbutfairsenseofprosocialbehavioralcontrol,positivesenseofself,respectforselfandothers,healthyinternalmotivation,curiosityandloveforlearning,andsoonthatoperateindependentlyoftheexternalenvironment.Thesefactorsenhancedevelopmentalgrowth,improveschoolfunctioning,andoptimizementalhealth,whilepreventingantisocialtendencies,violentbehavior,andsubstanceabuse.

PsychologicalIssuesRelatedtotheCrucialRoleofEmotionalAwarenessResearchsuggeststhataschildrendevelopmorecomplexandaccurateplansandstrategiesregardingemotions,theseplanshaveamajorinfluenceontheirsocialbehavior.Forexample,theabilitytothinkthroughproblemsituationsandtoanticipatetheiroccurrenceiscriticalforsociallycompetentbehavior.However,these“cold”cognitiveprocessesareunlikelytobeeffectivelyutilizedinrealworldconditions(e.g.,whenbeingteased)unlessthechildcanbothaccuratelyprocesstheemotionalcontentofthesituationandeffectivelyregulatehisorheremotionalarousalsothatheandshecanthinkthroughtheproblem.

Similarly,ifchildrenmisidentifytheirownfeelingsorthoseofothers,theyarelikelytogeneratemaladaptivesolutionstoaproblem,regardlessoftheirintellectualcapacities.Inadditiontothesetypesofchallenges,thechild’smotivationtodiscussthesefeelingsandproblem-solveininterpersonalcontextswillalsobegreatlyimpactedbythemodelingandreinforcementofadultsandpeers.

Emotionalawarenessandunderstandingareimplicitinmanymodelsthathavebeendevelopedtopromotesocialcompetence,buthaverarelybeenacentralfocus,eventhoughnumerousstudieshaveassessedsocialproblem-solvingabilityasbothamediatorandoutcomeofintervention.Recently,emotionalcompetencehasbeensubsumedunderanew,morepopularterm,emotionalintelligence(Goleman,1995;Mayer&Salovey,1997),definedastheabilitytorecognizeemotionalresponsesinoneself,otherpeople,andsituations,andusethisknowledgeineffectiveways(e.g.,inmanagingone’sownemotionalresponses,motivatingoneself,andhandlingrelationshipseffectively).“Self-awareness—recognizingafeelingasithappens—isthekeystoneofemotional

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intelligence….[T]heabilitytomonitorfeelingsfrommomenttomomentis[also]crucialtopsychologicalinsightandself-understanding.Aninabilitytonoticeourtruefeelingsleavesusattheirmercy.Peoplewithgreatercertaintyabouttheirfeelingsarebetterpilotsoftheirlives”(Goleman,1995,p.43).Thus,ithasbeenproposedthatemotionalintelligencemaybemoreimportantthancognitiveintelligenceinachievingsuccessandhappinessinlife.

Assuch,acentralfocusofPATHSisencouragingchildrentodiscussfeelings,experiences,opinions,andneedsthatarepersonallymeaningful,andmakingthemfeellistenedto,supported,andrespectedbybothteachersandpeers.Asaresult,theinternalizationoffeelingvalued,caredfor,appreciated,andpartofasocialgroupisfacilitated,which,inturn,motivateschildrentovalue,carefor,andappreciatethemselves,theirenvironment,theirsocialgroups,otherpeople,andtheirworld.

Thisfocuscannotbeemphasizedenough.Althoughallchildrenneedtofeellistenedtoorrespectedbyothers,especiallyadults,manychildrendonothaveanadultrolemodelwhowillsupporttheminthismanner;hence,theydonotlearntorespectthemselvesorothers.Theseaspectsofsocializationmustbetaughttochildren,andtobecometrulysocialized,childrenmustinternalizeandembracethemastheirown,hopefullypriortoreachingadolescence.Itisimportanttorecognize,however,thatthiscannotbeforceduponchildren,butratherisbestachievedthroughnurturanceandrespect.

BriefDescriptionofInterventionThePATHSCurriculumconsistsofanInstructionalManual,sixvolumesoflessons,pictures,photographs,posters,FeelingFaces,andadditionalmaterials.PATHSisdividedintothreemajorunits:(1)theReadinessandSelf-ControlUnit,12lessonsthatfocusonreadinessskillsanddevelopmentofbasicself-control;(2)theFeelingsandRelationshipsUnit,56lessonsthatfocusonteachingemotionalandinterpersonalunderstanding(i.e.,EmotionalIntelligence);and(3)theInterpersonalCognitiveProblem-SolvingUnit,33lessonsthatcoverelevenstepsforformalinterpersonalproblem-solving.TwofurtherareasoffocusinPATHSinvolvebuildingpositiveself-esteemandimprovingpeercommunications/relations.Ratherthanhavingseparateunitsonthesetopics,relevantlessonsareinterspersedthroughouttheotherthreeunits.ThereisalsoaSupplementaryUnitcontaining30lessonswhichreviewandextendPATHSconceptsthatarecoveredinthemajorthreeunits.ThePATHSunitscoverfiveconceptualdomains:

1. self-control,2. emotionalunderstanding,3. positiveselfesteem,

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4. relationships,and5. interpersonalproblemsolvingskills.

Eachofthesedomainshasavarietyofsub-goals,dependingontheparticulardevelopmentallevelandneedsofthechildrenreceivinginstruction.

PATHSisanexpansiveandflexibleprogramthatallowsimplementationofthe131lessonsovera5yearperiod,butitshouldbenotedthatanyparticularlessonisnotnecessarilyequivalenttoonesession;indeed,dependingontheneedsofanyspecificclassroom,onePATHSlessoncanrunfromonetofiveormorePATHSsessions.Picturesandphotographsareincludedforallofthelessons,withsmallergraphicsprovidedinthemarginsofthescriptstomakethecurriculummoreuser-friendly.MostofthematerialsthatareneededareincludedinThePATHSCurriculumkit,butsupplementarymaterialscancertainlybeaddedasdesired.

AseparatevolumeisalsoincludedwithPATHStoserveasanInstructionalManualforteachers.Toencouragegeneralizationtothehomeenvironment,parentlettersandinformationareprovidedperiodicallyinthecurricularlessonsandcanbesenthomebytheteachersasdesired.“Homeactivityassignments”(separateversionsforyoungerandolderstudents)arealsoincludedforchildrentodoathome(e.g.,Askyourmomordadorotheradultaboutatimewhentheyfeltproud)tofurtherinvolveparents(pleaseseeAppendicesEandF).

EvidenceofProgramEffectivenessThreecontrolledstudieswithrandomizedcontrolvs.experimentalgroups(usingoneyearofPATHSimplementationwithpre,post,andfollow-updata)havebeenconductedbythepresentauthors.Thesehaveincludedthreedifferentpopulationsincludingdeaf/hearingimpaired,regulareducation,andspecialeducation-classifiedchildren.

TherobustRCTevaluationofthePATHSprogrammeinCraigavon/Lurganshouldreportin2012.

IncreasingProtectiveFactorsInallthreeclinicaltrials,comparedtomatchedcontrolchildren,theuseofthePATHSCurriculumhassignificantlyincreasedthechildren’sabilityto:■ Recognizeandunderstandemotions■ Understandsocialproblems■ Developeffectivealternativesolutions■ Decreasethepercentageofaggressive/violentsolutions

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Inallthreegroupsofchildren,teachersreportsignificantimprovementsinchildren’sprosocialbehaviorinthefollowingdomains:

■ Self-control■ Emotionalunderstanding■ Abilitytotoleratefrustration■ Useofeffectiveconflict-resolutionstrategies

CognitivetestingindicatesthatPATHSleadstoimprovementsinthefollowingskills:

■ Abilitytoplanaheadtosolvecomplextaskswithnormalandspecialneedschildren(WISC-RBlockDesignandAnalogiesoftheTestofCognitiveAbilities;nottestedintheDeaf/Hearing-Impairedgroup)

■ Cognitiveflexibilityandlowimpulsivitywithnon-verbaltasks(CodingfromtheWISC-R)

■ Improvedreadingachievementforyoungdeafchildren

ReducingMaladaptiveOutcomesTeachersreportthefollowingreductionsinbehavioraldifficultiesatone-yearpostintervention:

■ Decreasedinternalizingsymptoms(sadness,anxiety,andwithdrawal)inspecialneedsclassrooms

■ Decreasedexternalizingsymptoms(aggressiveanddisruptivebehavior)inspecialeducationclassrooms

Students(inregularandspecialneedsclasses)self-reportthefollowingreductionsinbehavioraldifficultiesatone-yearpostintervention:

■ Decreasedsymptomsofsadnessanddepression(ChildDepressionInventory)■ Decreasedreportofconductproblems

InitialFindingfromtheNationalFastTrackDemonstrationProgramTheFT/PATHSCurriculum(arevisedversionofPATHSwhichmaintainsthecriticalcomponentsoftheoriginalcurriculum)isthecentraluniversalpreventioncomponentoftheFastTrackProgram.FastTrackisacomprehensiveprogramwhosegoalsincludethepreventionofaggressionanddelinquencyandthepromotionofsocialandacademiccompetence.TheFastTrackPrograminvolvesalongitudinaldesignandisconductedinfourAmericanlocations(Seattle,Nashville,Durham,andruralPennsylvania).Findingsattheendoffirstgrade(afteroneyearofimplementation)indicatethatinschoolsinwhichPATHSis

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operating,thereisimprovedsocialadaptation(ascomparedtomatchedcontrolschools)asindexedbymorepositivereportsofthefollowingdimensions:

■ Lowerpeeraggressionscoresbasedonpeerratings(Sociometrics)■ Lowerteacherratingsofdisruptivebehavior(Teacherreport)■ Improvedclassroomatmosphere(assessedbyIndependentObservers)


Greenberg,M.T.,Kusché,C.&Mihalic,S.F.(1998).BlueprintsforViolencePrevention,BookTen:PromotingAlternativeThinkingStrategies(PATHS).Boulder,CO:CenterfortheStudyandPreventionofViolence.

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INCREDIBLEYEARSSERIES(IYS)

ProgramSummaryTheIncredibleYearsSeriesisasetofthreecomprehensive,multi-faceted,anddevelopmentally-basedcurriculumsforparents,teachersandchildrendesignedtopromoteemotionalandsocialcompetenceandtoprevent,reduce,andtreatbehaviorandemotionproblemsinyoungchildren.

ProgramTargetsChildren,agestwototen,atriskforand/orpresentingwithconductproblems(definedashighratesofaggression,defiance,oppositionalandimpulsivebehaviors).Theprogramshavebeenevaluatedas“selected”preventionprogramsforpromotingthesocialadjustmentofhighriskchildreninpreschool(HeadStart)andelementarygrades(uptogradethree)andas“indicated”interventionsforchildrenexhibitingtheearlyonsetofconductproblems.

ProgramContentThisseriesofprogramsaddressesmultipleriskfactorsacrosssettingsknowntoberelatedtothedevelopmentofConductDisordersinchildren.Inallthreetrainingprograms,trainedfacilitatorsusevideotapescenestoencouragegroupdiscussion,problem-solving,andsharingofideas.TheBASICparentseriesis“core”andanecessarycomponentofthepreventionprogramdelivery.Theotherparenttraining,teacher,andchildcomponentsarestronglyrecommendedwithparticularpopulationsthataredetailedinthisdocument.

IncredibleYearsTrainingforParentsTheIncredibleYearsparentingseriesincludesthreeprogramstargetingparentsofhigh-riskchildrenand/orthosedisplayingbehaviorproblems.TheBASICprogramemphasizesparentingskillsknowntopromotechildren’ssocialcompetenceandreducebehaviorproblemssuchas:howtoplaywithchildren,helpingchildrenlearn,effectivepraiseanduseofincentives,effectivelimit-settingandstrategiestohandlemisbehavior.TheADVANCEprogramemphasizesparentinterpersonalskillssuchas:effectivecommunicationskills,angermanagement,problem-solvingbetweenadults,andwaystogiveandgetsupport.TheSUPPORTINGYOURCHILD’SEDUCATIONprogram(knownasSCHOOL)emphasizesparentingapproachesdesignedtopromotechildren’sacademicskillssuchas:readingskills,parentalinvolvementinsettinguppredictablehomeworkroutines,andbuildingcollaborativerelationshipswithteachers.

IncredibleYearsTrainingforTeachersThisseriesemphasizeseffectiveclassroommanagementskillssuchas:theeffectiveuseofteacherattention,praiseandencouragement,useofincentivesfordifficult

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behaviorproblems,proactiveteachingstrategies,howtomanageinappropriateclassroombehaviors,theimportanceofbuildingpositiverelationshipswithstudents,andhowtoteachempathy,socialskillsandproblem-solvingintheclassroom.

IncredibleYearsTrainingforChildrenTheDinosaurCurriculumemphasizestrainingchildreninskillssuchasemotionalliteracy,empathyorperspectivetaking,friendshipskills,angermanagement,interpersonalproblem-solving,schoolrulesandhowtobesuccessfulatschool.Thetreatmentversionisdesignedforuseasa“pullout”treatmentprogramforsmallgroupsofchildrenexhibitingconductproblems.Thepreventionversionisdeliveredtotheentireclassroombyregularteachers,twotothreetimesaweek.

ProgramOutcomesMultiplerandomizedcontrolgroupevaluationsoftheparentingseriesindicatesignificant:

■ Increasesinparentpositiveaffectsuchaspraiseandreduceduseofcriticismandnegativecommands.

■ Increasesinparentuseofeffectivelimit-settingbyreplacingspankingandharshdisciplinewithnon-violentdisciplinetechniquesandincreasedmonitoringofchildren.

■ Reductionsinparentaldepressionandincreasesinparentalself-confidence.■ Increasesinpositivefamilycommunicationandproblem-solving.■ Reducedconductproblemsinchildren’sinteractionswithparentsand

increasesintheirpositiveaffectandcompliancetoparentalcommands.

Multiplerandomizedcontrolgroupevaluationsoftheteachertrainingseriesindicatesignificant:

■ Increasesinteacheruseofpraiseandencouragementandreduceduseofcriticismandharshdiscipline.

■ Increasesinchildren’spositiveaffectandcooperationwithteachers,positiveinteractionswithpeers,schoolreadinessandengagementwithschoolactivities.

■ Reductionsinpeeraggressionintheclassroom.

Multiplerandomizedcontrolgroupevaluationsofthechildtrainingseriesindicatesignificant:

■ Increasesinchildren’sappropriatecognitiveproblem-solvingstrategiesandmoreprosocialconflictmanagementstrategieswithpeers.

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■ Reductionsinconductproblemsathomeandschool.

IndependentreplicationsinEngland,Wales,Norway,Canada,andtheUSconfirmthesefindings.

ProgramCostsThecostsofcurriculummaterials,includingvideoorDVDs,comprehensivemanuals,booksandotherteachingaidsfortheParentTrainingProgramare$1,300fortheBASICprogram,$775fortheADVANCEprogram,$1250fortheSCHOOLprogram;$1,250fortheTeacherTrainingProgram;and$1250fortheChildTrainingProgram.Discountsareavailableforpurchasesofmorethanonesetofanyprogram.Trainingandtechnicalassistancecostsarechargedbasedonadailyfee.

ProgramBackgroundThemissionoftheIncredibleYearsTrainingSeriesistopromotepositive,effective,andresearch-basedparentingandteachingpracticesandstrategieswhichstrengthenyoungchildren’ssocialcompetenceandproblem-solvingstrategiesandreduceaggressionathomeandatschool.Therearethreetypesofinterlockingtrainingcurriculums,whicharetargetedatparents,teachersandchildren(agestwotoeightyears).Initially,inthe1980’s,theBASICparentprogramwasevaluatedandfoundtobeverysuccessfulinpromotingpositiveandlastingimprovementsinparent-childinteractionsandinreducingchildren’sbehaviorproblemsathomeforatleasttwo-thirdsofchildren.However,afollow-upevaluationthreeyearslaterindicatedthatapproximatelyone-thirdofthechildrenwerestillhavingconsiderabledifficultiesatschoolandwithpeergroups.Improvementsathomedidnotnecessarilygeneralizetoschoolsettingsortopeerinteractionsforsomechildren.Inparticular,stressfulfamilysituations(e.g.,maritaldistressandpoverty)wererelatedtopooreroutcomes.Asaresultofthesefindings,twonewcomponentsweredeveloped:(1)theADVANCEparentprogramfocusingoncommunication,angermanagementandproblem-solvingskillsand,(2)thechildprogram(DinaDinosaurCurriculum)designedtotrainchildreninsocialskills,problem-solvingstrategiesandemotionallanguage.Evaluationofthesecomponentsindicatedthattheprogramsenhancedeffectsintermsofpeerrelationships,socialproblem-solvingandmaritalcollaboration.However,itwasstillevidentthataportionofthechildrenandtheirfamilieswerehavingdifficultiesmanagingtheschoolexperienceandworkingsuccessfullywithteachers.Inparticular,about40percentofthechildrenwerefoundtobeco-morbidforotherproblemssuchasAttentionDeficitHyperactivityDisorder,aswellaslanguageandlearningdelays.Theseproblemscreatedparticulardifficultiesforthechildrenintheclassroom,withteachersandwithpeers.Moreover,parentsofthesechildrenwerehavingdifficultyknowinghowtosuccessfullycollaboratewithteachersin

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planningfortheiracademicandsocialneeds.Consequently,forthepastsixyears,ateachertrainingcurriculumhasbeendevelopedandevaluatedforuseinteachingpositiveclassroommanagementskillsandpromotingsocial,emotionalandacademiccompetenciesintheclassroom.Inconjunctionwiththisprogram,theSupportingYouthChild’sEducation(SCHOOL)programforparentswasdevelopedtohelpparentslearnhowtofosteracademiccompetenceathome(e.g.,readingskillsandstudyhabits)andhavesuccessfulconferenceswithteachersatschool.Recentevaluationsoftheseprogramsindicatedsignificanteffectsindecreasingclassroomaggressionandincreasingacademiccompetence.

Thesecurriculumsmaybeusedinschools(e.g.,HeadStart,daycare,andkindergartenthroughgradethree)asearlypreventionprogramsforhigh-riskchildrenandtheirfamiliesandaredesignedtobuildprotectivefactors(e.g.,angermanagement,empathyskills,positivedisciplineandhome-schoolcollaboration)andreduceriskfactors(e.g.,earlysignsofaggressionandpeerrejection)thatresearchhasshowntoberelatedtolaterviolence.Additionally,thesecurriculumsmaybeusedinmentalhealthcentersastreatmentprogramsforchildrendiagnosedwithearly-onsetOppositionalDefiantDisorder(ODD)orConductDisorder(CD)andAttentionDeficitHyperactivityDisorder(ADHD).Thelongrangegoalofthesepreventionprogramsistoenhanceyoungchildren’ssocial,emotional,andacademicdevelopment,aswellaspreventandreduceconductproblemsinordertodecreaseviolence,drugabuse,anddelinquencyinlateryears.

ConductProblemsinYoungChildrenTheincidenceofaggressioninchildrenisescalating—andatyoungerages.Studiesindicatethatanywherefrom7to20percentofpre-schoolandearlyschoolagechildrenmeetthediagnosticcriteriaforOppositionalDefiantDisorder(ODD)andConductDisorder(CD).Theseratesareevenhigherforlow-incomefamilies.ResearchonthetreatmentandpreventionofConductDisordershasbeenidentifiedasoneofthenation’shighestpriorities.Thisagendaisvitallyimportantbecausethewidespreadoccurrenceofdelinquencyandescalatingviolenceinadolescenceresultinahighcosttosociety.“Earlyonset”ODD/CD(intheformofhighratesofoppositionaldefiance,aggressiveandnoncompliantbehaviors)isastabletraitovertimeformanypreschoolchildrenandappearstobethemostimportantbehavioralriskfactorforantisocialbehaviorforboysandgirlsinadolescence.Suchbehaviorhasrepeatedlybeenfoundtopredictthedevelopmentofdrugabuseinadolescence,aswellasotherproblems,includingjuveniledelinquency,depression,violentbehavior,andschooldropout.

Theoriesregardingthecausesofchildconductproblemsincludechildbiologicalanddevelopmentalriskfactors(e.g.,attentiondeficitdisorders,learningdisabilities,andlanguagedelays);familyfactors(e.g.,maritalconflict,depression,

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drugabuse,andcriminalbehavior);ineffectiveparenting(e.g.,harshdisciplineandlowparentalinvolvementinschoolactivities);schoolriskfactors(e.g.,teachers’useofpoorclassroommanagementstrategies,classroomlevelofaggression,largeclasssizesandlowteacherinvolvementwithparents);andpeerandcommunityriskfactors(e.g.,povertyandgangs).

SinceConductDisorderbecomesincreasinglyresistanttochangeovertime,interventionthatbeginsintheearlyschoolyearsisclearlyastrategicwaytopreventorreduceaggressivebehaviorproblemsbeforethey“ripple”toresultinwell-establishednegativereputations,academicfailure,andescalatingviolenceinadolescence.Recentprojectionssuggestthatapproximately70percentofthechildrenwhoneedservicesforconductproblems—inparticular,youngchildren—donotreceivethem.Andveryfewofthosewhodoreceiveinterventioneverreceiveaninterventionwhichhasbeen“empiricallyvalidated.”

HighlightsoftheIncredibleYearsParent,TeacherandChildTrainingSeries

■ Comprehensive(includesintegratedtrainingforparents,teachersandchildren)

■ Proactive,collaborativeapproachbuiltonthe“strengthmodel”■ Flexibleindeliveryusingsequencedmodules(26topicsintotal)■ Culturallysensitive(availableinSpanish,Britishdialect,andNorwegian,as

wellasmulti-ethnicvideotapeactorsandpuppets)■ Appropriateforpreventionprogramsforhigh-riskchildren,aswellasfor

treatmentofchildrenwithconductproblems■ Userfriendly—usesacombinationofbooks,videotapes,extensivefacilitator

manuals,andhomeandschoolactivities■ Developmentallyappropriateforyoungchildren—includespuppets,gamesand

activities■ Providesextensiveprogramsupportfortrainingfacilitators,schoolpersonnel,

andorganizations,includinggroupfacilitatortraining■ Providescertificationforfacilitatorstoassurequalityimplementation■ Evidence-basedandreplicatedbyindependentresearchers

TheoreticalRationale/ConceptualFrameworkThetheoreticalrationaleforthethreecurriculumsforparents,teachers,andchildrenisdescribedbelow.

TheoreticalRationale/ConceptualFrameworkfortheIncredibleYearsParentTrainingSeriesParentinginteractionsareclearlythemostwellresearchedandmostimportantproximalcauseofthedevelopmentofconductproblemsinyoungchildren.

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Parentingpracticesassociatedwiththedevelopmentofconductproblemsincludepermissive,inconsistent,irritable,andharshdisciplineandlowmonitoring.DishionandLoeber(1985)andothershavefoundthatparentalmonitoringanddisciplinearelowforadolescentsubstanceabusers;moreover,theseparentalconstructsatagetenpredictedlaterantisocialbehavioranddrugabuse.ThemostinfluentialdevelopmentalmodelfordescribingthefamilydynamicsthatunderlieearlyantisocialbehaviorisPatterson’ssociallearningtheoryregardingthe“coerciveprocess”(Pattersonetal.,1992),apatternwherebychildrenlearntoescapeoravoidparentalcriticismbyescalatingtheirnegativebehaviors.This,inturn,leadstoincreasinglyaversiveparentinteractionsandescalatingdysregulationonthepartofthechild.Thesenegativeparentresponsesdirectlymodelandreinforcethechild’sdeviantbehaviors.

Inadditiontosociallearningtheory,attachmenttheory(Bowlby,1980)andnewmethodsofmeasuringattachmentbeyondthetoddlerhoodperiodhaveemphasizedtheimportanceoftheaffectivenatureoftheparent-childrelationship.Considerableevidenceindicatesthatawarm,positivebondbetweenparentandchildleadstomorepositivecommunicationandpositiveparentingstrategiesandamoresociallycompetentchild,whereashighlevelsofparentalnegativeaffectandhostilityisdisruptivetochildren’sabilitytoregulatetheiremotionalresponsesandmanageconflictappropriately.Forexample,researchhasshownthattherelationshipbetweenharshdisciplineandexternalizingproblemsoccursonlyamongchildreninhomesinwhichawarmchild-parentrelationshipislacking(Deater-Deckard,Dodge,Bates,&Pettit,1996).Likewise,inarecentreviewofresearchonriskandresilience,DollandLyon(1998)concludethatawarmrelationshipwithatleastonecaregiverisastrongprotectivefactoragainstthenegativeinfluencesoffamilydysfunction.Thisfindingissupportedbyresultsofalargenationalstudyofadolescentdevelopmentthatshowedthatyouthwhoreportpositiverelationshipsandbondingwiththeirfamiliesandschoolsengageinlessriskyandfewerantisocialbehaviors(Resnicketal.,1997).

Otherfamilyfactors,suchasdepression,maritalconflict,andhighnegativelifestress,havebeenshowntodisruptparentingskillsandcontributetoparentalhighnegativeaffect,inconsistentparenting,lowmonitoring,emotionalunavailabilityandinsecureattachmentstatus.Familyandparentingriskfactorresearchsuggeststheneedtotrainparentsineffectivechildmanagementskillsandassistthemincopingwithotherfamilystressors.

TheoreticalRationale/ConceptualFrameworkfortheIncredibleYearsTeacherTrainingSeriesOncechildrenwithbehaviorproblemsenterschool,negativeacademicandsocialexperiencesmakekeycontributionstothefurtherdevelopmentofconduct

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problems.Aggressive,disruptivechildrenquicklybecomesociallyexcluded,leadingtofeweropportunitiestointeractsociallyandlearnappropriatefriendshipskills.Overtime,peersbecomemistrustfulandrespondtoaggressivechildreninwaysthatincreasethelikelihoodofreactiveaggression.Evidencesuggeststhatpeerrejectioneventuallyleadstothesechildren’sassociationwithdeviantpeers.Oncechildrenhaveformeddeviantpeergroups,theriskfordrugabuseandantisocialbehaviorisevenhigher.

Furthermore,Rutterandcolleagues(1976)findthatteacherbehaviorsandschoolcharacteristicssuchaslowemphasisofteachersonacademicwork,lowratesofpraise,littleemphasisonindividualresponsibility,andhighstudent-teacherratioarerelatedtoclassroomaggressivebehaviors,delinquency,andpooracademicperformance.High-riskchildrenareoftenclusteredinclassroomswithahighdensityofotherhigh-riskstudents,thuspresentingtheteacherwithadditionalmanagementchallenges.Rejectingandnon-supportiveresponsesfromteachersfurtherexacerbatetheproblemsofaggressivechildren.Suchchildrenoftendeveloppoorrelationshipswithteachersandreceivelesssupport,nurturing,andinstructionandmorecriticismintheclassroom.Someevidencesuggeststhatteachersretaliateinamannersimilartoparentsandpeers.WalkerandBuckley(Walker,1995;Walker&Buckley,1973)reportthatantisocialchildrenarelesslikelytoreceiveencouragementfromteachersforappropriatebehaviorandmorelikelytobepunishedfornegativebehaviorthanwell-behavedchildren.Aggressivechildrenarealsofrequentlyexpelledfromclassrooms.Inourownclinicstudieswithconductproblemchildrenagedthreetosevenyears,over50percenthadbeenaskedtoleavethreeormoreschoolsbysecondgrade.Thelackofteachersupportandexclusionfromtheclassroomexacerbatesnotonlythesechildren’ssocialproblems,butalsotheiracademicdifficulties,andalsocontributestothelikelihoodofschooldropout.Finally,recentresearchhasshownthatpoorlymanagedclassroomshavehigherlevelsofclassroomaggressionandrejectionthat,inturn,influencethecontinuingescalationofindividualchildbehaviorproblems.Aspiralingpatternofchildnegativebehaviorandteacherreactivitycanultimatelyleadtoparentdemoralization,withdrawalandalackofconnectionandconsistencybetweenthesocializationactivitiesoftheschoolandhome.Whilemostteacherswanttobeactivepartnersinfacilitatingthebondingprocesswithparents,manylacktheconfidence,skills,ortrainingtoworkcollaborativelywithfamilies.Teachereducationprogramsalsodevotescantattentiontobuildingrelationshipsandpartnershipswithparentsorimplementingsocialandemotionalliteracycurriculums.

Thisliteraturesuggeststhatapreventivemodelneedstopromotehealthybondsor“supportivenetworks”betweenteachersandparentsandchildrenandteachers.Strongfamily-schoolnetworksbenefitchildrenduetoparents’

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increasedexpectations,interestin,andsupportfortheirchild’ssocialandacademicperformance,andcreateaconsistentsocializationprocessacrosshomeandschoolsettings.Thenegativecycledescribedabovecanbepreventedwhenteachersdevelopnurturingrelationshipswithstudents,establishclearclassroomrulesaboutbullying,preventsocialisolationbypeers,andofferacurriculumwhichincludestrainingstudentsinemotionalliteracy,socialskills,andconflictmanagement.Considerableresearchhasdemonstratedthateffectiveclassroommanagementcanreducedisruptivebehaviorandenhancesocialandacademicachievement.Well-trainedteacherscanhelpaggressive,disruptive,anduncooperativechildrendeveloptheappropriatesocialbehaviorthatisaprerequisitefortheirsuccessinschool.Teacherbehaviorsassociatedwithimprovedclassroombehaviorincludethefollowing:highlevelsofpraiseandsocialreinforcement;proactivestrategiessuchaspreparingchildrenfortransitionsandsettingclear,predictableclassroomrules;effectiveuseofshort,clearcommands,warnings,reminders,anddistractions;tangiblereinforcementsystemsforappropriatesocialbehavior;team-basedrewards;mildbutconsistentresponsecostsforaggressiveordisruptivebehaviorincludingTimeOutandlossofprivileges;anddirectinstructioninappropriatesocialandclassroombehavior,problem-solvingandself-managementskills.

TheoreticalRationale/ConceptualFrameworkfortheIncredibleYearsChildTrainingSeriesMoffit(Moffitt,1993;Moffitt&Lynam,1994)andothershavearguedthatsomeabnormalaspectofthechild’sinternalorganizationatthephysiological,neurological,and/orneuropsychologicallevel(whichmaybegeneticallytransmitted)islinkedtothedevelopmentofConductDisorders,particularlyfor“lifecoursepersisters”(i.e.,thosewithachronichistoryofearlybehavioralproblems).

Childrenwithconductproblemshavebeenreportedtohavecertaintemperamentalcharacteristicssuchasinattentiveness,impulsivity,andHyperactivityAttentionDeficitDisorder.Researchersconcernedwiththebiologicalaspectsofthedevelopmentofconductproblemshaveinvestigatedvariablessuchasneurotransmitters,autonomicarousalsystem,skinconductanceandhormonalinfluences,andsomefindingssuggestthatsuchchildrenmayhavelowautonomicreactivity(i.e.,lowphysiologicalresponsetostimuli).OtherchildfactorshavealsobeenimplicatedinchildConductDisorder.Forexample,deficitsinsocial-cognitiveskillscontributetopooremotionalregulationandaggressivepeerinteractions.ResearchhasshownthatchildrenwithODD/CDmaydefineproblemsinhostileways,searchforfewercueswhendetermininganother’sintentionsandfocusmoreonaggressivecues.ChildrenwithODD/CDmayalsodistortsocialcuesduringpeerinteractions,generatefeweralternativesolutionstosocialproblems,and

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anticipatefewerconsequencesforaggression.Thechild’sperceptionofhostileintentinothersmayencouragethechildtoreactaggressively.Researchrevealsthataggressivebehaviorinchildreniscorrelatedwithlowempathyacrossawideagerangewhichmaycontributetoalackofsocialcompetencyandantisocialbehavior.Additionally,studiesindicatethatchildrenwithconductproblemshavesignificantdelaysintheirpeerplayskills;inparticular,difficultywithreciprocalplay,cooperativeskills,turntaking,waiting,andgivingsuggestions.

Finally,reading,learningandlanguagedelaysarealsoimplicatedinchildrenwithconductproblems,particularlyfor“earlylifecoursepersisters”(Moffitt&Lynam,1994).Forthesechildren,lowacademicachievementoftenmanifestsitselfduringtheelementarygradesandcontinuesthroughhighschool.Pooracademicachievementalsopredictsadolescentdrugabuseinbothcross-sectional(Jessor,1987;Newcomer,Maddahian,&Bentler,1986)andlongitudinalsamples(Smith&Fogg,1978).TherelationshipbetweenacademicperformanceandCDisbi-directional.Academicdifficultiesmaycausedisengagement,increasedfrustration,andlowerself-esteem,whichcontributetothechild’sbehaviorproblems.Atthesametime,noncompliance,aggression,elevatedactivitylevels,andpoorattentionlimitachild’sabilitytobeengagedinlearningandachieveacademically.Thus,acycleiscreatedinwhichoneproblemexacerbatestheother.ThiscombinationofacademicdelaysandconductproblemsappearstocontributetothedevelopmentofmoresevereCDandschoolfailure.

Thedataconcerningthepossiblebiological,socio-cognitiveandacademicordevelopmentaldeficitsinchildrenwithconductproblemssuggesttheneedforparentandteachertrainingprogramswhichhelpthemunderstandchildren’sbiologicaldeficits(theirunresponsivenesstoaversivestimuliandheightenedinterestinnovelty)andsupporttheiruseofeffectiveparentingandteachingapproachessothattheycancontinuetobepositiveandprovideconsistentresponses.Thedataregardingautonomicunderarousaltheorysuggeststhatthesechildrenmayrequireoverteaching(i.e.,repeatedlearningtrials)inordertolearntoinhibitundesirablebehaviorsandmanageemotion.Parentsandteacherswillneedtouseconsistent,clear,specificlimit-settingthatutilizessimplelanguageandconcretecuesandreminders.Additionally,thisinformationsuggeststheneedtodirectlyintervenewithchildrenandfocusonsociallearningneedssuchasproblem-solving,perspectivetaking,andplayskillsaswellasliteracyandspecialacademicneeds.

BriefDescriptionofInterventionTheIncredibleYearsSeriesisacomprehensiveprogramforparents,teachers,andchildrenwiththegoalofpreventing,reducing,andtreatingbehavioralandemotionalproblemsinchildrenagestwotoeight.Thecoreoftheprogram

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istheBASICparenttrainingcomponentwhichemphasizesparentingskillssuchasplayingwithchildren;helpingchildrenlearn;usingeffectivepraise,incentives,andlimit-setting;andhandlingmisbehavior.AdditionalparenttrainingcomponentsincludeanADVANCEserieswhichemphasizesparentinterpersonalskillssuchaseffectivecommunication,angermanagement,problem-solvingbetweenadults,andwaystogiveandgetsupport,andaSCHOOLserieswhichfocusesonparentingapproachesdesignedtopromotechildren’sacademicskills.

Tofacilitategeneralizationfromhometotheschoolenvironment,atrainingseriesforteachersprovidingeffectiveclassroommanagementskillswasaddedtotheIncredibleYearsSeries.Thelastadditionwasthetrainingseriesforchildren(DinaDinosaurCurriculum),a“pullout”treatmentprogramforsmallgroupsofchildrenexhibitingconductproblems.Thiscurriculumemphasizesemotionalliteracy,empathyandperspectivetaking,friendshipdevelopment,angermanagement,interpersonalproblem-solving,followingschoolrules,andschoolsuccess.

TheBASICcomponent,whichisthecoreprogram,MUSTbeimplemented,andothercomponentsmaybeaddedaccordingtotheparticularfamilyandchildriskfactors.Abriefdescriptionoftheparent,teacher,andchildprogramsisprovidedbelow.

ParentTrainingProgramsBASIC.TheBASICparenttrainingprogramisguidedbythecognitivesociallearningandattachmentrelationshiptheoriesdescribedabove.Itisa12to14weekprogramforparentsinvolvingfacilitator-ledgroupdiscussionsof250videovignettes.Theprogramteachesparentschild-directedinteractiveplay,empathy,andreinforcementskills,whichhelpparentsachievearealistic,develop-mentallyappropriateunderstandingoftheirchildrenandtheirtemperamentsinordertofosterattachmentandnurturingrelationships.Thelatterhalfoftheprogramfocusesonnonviolentdisciplinetechniques,including“TimeOut”and“Ignore,”logicalandnaturalconsequences,andproblem-solvingstrategies.Finally,theprogramteachesparentsappropriatemonitoringstrategiesandhowtorespondtochildreninclear,predictableways.Theschool-ageversionoftheBASICparenttrainingseries(developedwithamoreculturallydiversepopulation)isdesignedforusewithparentsofchildrenuptoageeight(gradethree).

SCHOOL.TheSupportingYourChild’sEducation(SCHOOL)programwasdesignedtoteachparentstostrengthentheirchild’sreadingandacademicreadinessandpromotestrongconnectionsbetweenhomeandschoolbydevelopingpartnershipswithteachers.

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ADVANCE.TheADVANCEparenttrainingprogramisalsoguidedbycognitivesociallearningtheoryandutilizeseffectiveaspectsofmaritalanddepressiontherapy(Jacobson,Schmaling,&Holtzworth-Monroe,1987).Thisprogramisa10to12weeksupplementtotheBASICprogramandaddressesotherfamilyriskfactorssuchasdepression,maritaldiscord,poorcopingskills,andlackofsupport.Theprogramcontentincludesteachingcognitiveself-controlstrategies,problem-solving,communicationskillsandwaystogiveandgetsupport.Figure1.ParentingPyramid

Allofthetrainingprogramsutilizeacollaborativetrainingprocessofgroupdiscussionguidedbytrainedfacilitators,andprogrammaterialsincludevideotapes,detailedmanualsforfacilitators,parentbooksandaudiotapes,andhomeactivitiesandrefrigeratornotes.

Problem Solving

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TeacherTrainingProgramTheteachertrainingprogramincludesasix-day(or42-hour)workshopforteachers,schoolcounselors,andpsychologiststhatinvolvesgroup-basedtrainingtotargeteffectiveclassroommanagementstrategiesfordealingwithmisbehavior;promotingpositiverelationshipswithdifficultstudents;strengtheningsocialskillsintheclassroom,playground,bus,andlunchroom;andteachers’collaborativeprocessandpositivecommunicationwithparents(e.g.,theimportanceofpositivehomephonecalls,regularmeetingswithparents,homevisits,andsuccessfulparentconferences).Forindicatedchildren(i.e.,childrenwithConductDisorder),teachers,parents,andgroupfacilitatorswilljointlydevelop“transitionplans”thatdetailclassroomstrategiesthataresuccessfulwitheachindividualchild;goalsachievedandremaining;characteristics,interests,andmotivatorsforthechild;andpreferredmethodsofcontactingparents.Thisinformationispassedontothefollowingyear’steachers.Figure2.PyramidforBuildingRelationships

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Additionally,teacherslearnhowtopreventpeerrejectionbyteachingtheaggressivechildappropriateproblem-solvingstrategiesandhelpinghis/herpeersrespondappropriatelytoaggression.Teachersareencouragedtobesensitivetoindividualdevelopmentaldifferences(i.e.,variationinattentionspanandactivitylevel)andbiologicaldeficitsinchildren(e.g.,unresponsivenesstoaversivestimuli,heightenedinterestinnovelty),aswellashowtorespondtothesedifferencesinpositive,acceptingandconsistentways.Physicalaggressioninunstructuredsettings(e.g.,playground)istargetedforclosemonitoring,instructionandincentiveprograms.Figure3.TeachingPyramid

ChildTrainingProgram(DinosaurCurriculum)DinaDinosaur’sSocialSkillsandProblem-SolvingCurriculumwasguidedbychildriskfactorresearchandaimstoenhancechildren’sappropriateclassroombehaviors(e.g.,quiethandupandlisteningtoteacher),promotesocialskillsand

Problem Solving

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positivepeerinteractions(e.g.,waiting,takingturns,askingtoenteragroupandcomplimenting,etc.),helpchildrendevelopappropriateconflictmanagementstrategies,andreduceconductproblems.Inaddition,theprogramteacheschildrenwaystointegrateintotheclassroomanddeveloppositivefriendships.Thecurriculumisusedasa“pullout”programfortreatingsmallgroupsoffivetosixchildrenwithconductproblems.Thesesmallgroupsessionscanbeofferedtwiceaweekforanhouroronceaweekfortwohours(see“FutureDirections”forhowprogramisusedasaclassroom-basedcurriculum).Finally,thechildprogramisorganizedtodovetailtheparentandteachertrainingprograms.

SummaryEachofthethreetypesoftrainingprogramsdescribedabovetargetsdifferentantecedentsofConductDisorderinthehome,classroom,andschoolsetting,aswellasintheindividualchildandhis/herpeergroup.Eachofthethreesetsofcurriculumshasbeendesignedtobepractical,“userfriendly,”andimplementedbytrainedfacilitatorsincludingschoolpersonnel.Initially,thesefacilitatorswillreceiveextensive,group-basedtrainingtoconducttheclassroomandparentinterventions.Additionally,self-administeredmanualshavebeendevelopedfortheteacherandparenttrainingprogramssothatparticipantscanmake-upmissedsessionsinacost-effectivemanner.

Eachofthethreeinterventionsincludesa500pagemanualoutliningcontent;groupfacilitatorscripts(includingquestionsforgroupdiscussions);homeworkorclassroomactivities;refrigeratorandblackboardnotesoutliningkeypoints;videos;andbooksforchildren,parents,andteachers.

Trainedgroupfacilitatorsusethevideotapedvignettestofacilitatediscussion,problem-solving,andsharingofideasamongteachers.Groupfacilitatorshelpparticipantsdiscussimportantprinciplesandpracticenewskillsthroughrole-playingandclassroomassignments.

EvidenceofProgramEffectiveness

IncredibleYearsParentTrainingStudieswithChildrenDiagnosedwithOppositionalDefiantDisorderand/orConductDisorderOverthepast20years,theBASICprogramhasbeenevaluatedextensivelyasatreatmentprograminaseriesofsixrandomizedstudieswithmorethan800childrenreferredtotheprogramforconductproblems.ThesestudieshaveshownthattheBASICprogramresultsinsignificantlyimprovedparentalattitudesandparent-childinteraction,areductioninparents’useofviolentformsofdiscipline,andreducedchildconductproblems.Effectshavebeensustaineduptothreeyearsafterintervention(Webster-Stratton,1990b).

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TheADVANCEprogramhasbeenshowninarandomizedstudytobeahighlyeffectivetreatmentforpromotingparents’useofeffectiveproblem-solvingandcommunicationskills,reducingmaternaldepression,andincreasingchildren’ssocialandproblem-solvingskills.TheseeffectswereobtainedoverandabovethesignificantchangesobtainedintheBASICprogram(Webster-Stratton,1994).LaterstudiescombiningBASICandADVANCEreplicatedthesefindingsandhaveshowneffectslastinguptoone4year(Webster-Stratton&Hammond,1997).Usershavebeenhighlysatisfiedwithbothprograms,andthedrop-outrateshavebeenlowregardlessofsocioeconomicstatus.

IncredibleYearsParentTrainingStudieswithHigh-riskFamiliesTheBASICprogramwasalsoevaluatedasaselectivepreventionprogramintworandomizedtrialswithover500HeadStartfamiliesrepresentingamulti-ethnic(50percentminority)populationlivinginpovertysituations.Inthefirststudy,resultsindicatedthattheparentingskillsofHeadStartparentswhoreceivedtrainingandthesocialcompetenceoftheirchildrensignificantlyimprovedcomparedwiththecontrolgroupfamilies.Thisdatasupportedthehypothesisthatstrengtheningparentingcompetenceandincreasingtheparentalinvolvementofhigh-riskwelfaremothersinchildren’sschool-relatedactivitieshelpstopreventchildren’sconductproblemsandpromotesocialcompetence(Webster-Stratton,1998b;Webster-Stratton&Reid,1999a).Mostoftheseimprovementsweremaintainedoneyearlater.ThesecondstudyreplicatedthefindingsofthefirststudywithHeadStartparentsandalsoevaluatedaddingasecondyearboosterparentinterventionutilizingabbreviatedcomponentsoftheADVANCEandSCHOOLprograms(Webster-Stratton,Reid&Hammond,inpress).Two-yearfollow-upresultsofthisstudyarecurrentlybeingconducted.

Thesefindingshavebeenindependentlyreplicatedinthreeotherstudieswithfamiliesofchildrenwithconductproblems(Scott,1999;Taylor,Schmidt,Pepler,&Hodgins,1998;Miller,Kamboukos,Klein,&Coard,1999)andinthreepreventiontrialsinlowincomechildcarecenterswithprimarilyAfricanAmericanfamiliesinChicago(Gross,Fogg,&Tucker,1995;Gross,Fogg,Webster-Stratton,&Grady,1999),withSpanish-speakingHeadStartfamiliesinNewYork(Miller&Rojas-Flores,1999),andwithamulti-ethnicgroupofHeadStartparentsinMassachusetts(Arnoldetal.,inprogress).

IncredibleYearsTeacherTrainingStudiesTheteachertrainingprogramwasfirstevaluatedinarandomizedtrialwith133childrendiagnosedwithconductproblems,andanalysescomparedchildtrainingandparenttrainingwithandwithoutteachertraining.Post-treatmentclassroomobservationsofteacherbehaviorconsistentlyfavoredconditionsinwhichteachersreceivedtraining.Trainedteacherswerelesscriticalandlessharshthancontrol

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teachers.Trainedteachersusedmorepraiseandweremorenurturing,lessinconsistent,andreportedmoreconfidenceinteachingthancontrolteachers.Resultsalsoindicatedthatinclassroomswhereteachersweretrained,childrenwereobservedtobesignificantlylessaggressivewithpeersandweremorecooperativewithteachersthanchildreninuntrainedteacherclassrooms.Trainedteachersalsoreportedthatchildrenhadincreasedacademiccompetencecomparedtochildrenincontrolclassrooms(Webster-Stratton&Reid,1999).Nearlyidenticalfindingsemergedinarandomizedtrialwith272HeadStartchildrenwhereinteachersandparentsreceivedthetrainingprogramsandwerecomparedwiththosereceivingregularHeadStartservices.Additionally,inclassroomswhereteachersreceivedtraining,childrenwereobservedtohavehigherschoolreadinessscores(engagementandon-taskbehavior)andincreasedpro-socialbehaviors,aswellassignificantlyreducedpeeraggression.Teachers’reportsofparentbondingandinvolvementinschool,aswellaschildren’ssocialcompetence,werealsosignificantlyhigherfortrainedteachersthanforuntrainedteachers.

ThesefindingshavebeenindependentlyreplicatedbyArnold(inprogress)inarandomizedstudyinvolvingeightdaycarecenters(12interventionand8controlclassrooms).Resultsindicatedthatteachersintheinterventionclassroomsreportedusingmoreeffectiveteachingstrategiesandlesslaxdisciplinethanteachersincontrolclassrooms.Moreover,interventionteachersreportedfeweraggressivebehaviorsthandidteachersincontrolclassrooms.

IncredibleYearsChildTrainingStudies—DinaDinosaurCurriculumTheDinaDinosaurCurriculumforchildrenwasevaluatedintworandomizedtrialswithconduct-disorderedchildrenagesfourtoeight.Thefirstofthesestudiesshowedthatthe20to22weekchildtrainingprogramresultedinsignificantimprovementsinobservationsofpeerinteractions.ChildrenwhohadreceivedtheDinosaurCurriculumweresignificantlymorepositiveintheirsocialskillsandconflictmanagementstrategiesthanchildrenwhoseparentsreceivedparenttrainingonlyorservedasuntreatedcontrols.Resultsshowedthatthecombinedparentandchildtrainingwasmoreeffectivethanparenttrainingaloneandthatbothweresuperiortothecontrolgroup.Oneyearlater,thecombinedparentandchildinterventionshowedthemostsustainedeffects.

Inthesecondstudy,theeffectsofthe20to22weekchildtrainingprogramwerereplicatedintermsofimprovedpeerconflictmanagementskillsincomparisontochildrenwhoonlyreceivedparenttraining(Webster-Stratton&Reid,1999).Whenchildtrainingwascombinedwithteachertraining,therewereimprovedreductionsinaggressivebehaviorintheclassroom.

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SummaryofResultsTheIncredibleYearstrainingprogramshavebeenshowntoaffectthefollowingriskandprotectivefactors:

Parents■ Increasedpositiveandnurturingparentingstyle■ Decreasedharsh,inconsistentandunnecessarydiscipline■ Increasedpraiseandeffectivediscipline■ Decreasedparentalstressanddepression■ Increasedpositiveparentcommandsandproblem-solving■ Increasedparentbondingandinvolvementwithteachers

Teachers■ Increasedproactiveandpositiveclassroommanagementskills■ Decreasedharshandcriticalclassroommanagementstyle■ Increasedpositiveclassroomatmosphere■ Increasedbondingwithparents

Child■ Increasedpositiveconflictmanagementskillsandsocialskillswithpeers■ Decreasednegativebehaviorsandnoncompliancewithparentsathome■ Increasedsocialcompetenceatschool■ Decreasedpeeraggressionanddisruptivebehaviorsintheclassroom■ Increasedacademicengagement,schoolreadinessandcooperationwith

teachers

Thesefindingshavebeenreflectedinteacherandparentratings,childtestingandinterviewing,independentobservationsinthehomeandatschool,andlaboratoryobservationsofpeerinteractionsandinteractionswithparents.

Thisinformationwasexcerptedfrom:

Webster-Stratton,C.,Mihalic,S.,Fagan,A.,Arnold,D.,Taylor,T.,&Tingley,C.(2001).BlueprintsforViolencePrevention,BookEleven:TheIncredibleYears:Parent,TeacherAndChildTrainingSeries.Boulder,CO:CenterfortheStudyandPreventionofViolence.

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TRIPLEP-POSITIVEPARENTINGPROGRAM

ProgramOverviewTheTripleP(PositiveParentingProgram)isacomprehensive,community-widesystemofparentingandfamilysupport.Thefiveinterventionlevelsweredesignedtoenhanceparentalcompetenceandpreventoralterdysfunctionalparentingpractices,therebyreducinganimportantsetoffamilyriskfactorsbothforchildmaltreatmentandforchildren’sbehavioralandemotionalproblems.Atthepopulationlevel,theexistingworkforcecrossingseveraldisciplinesandsettings(suchasfamilyandsocialsupportservices,preschoolandchildcaresettings,elementaryschoolsandothercommunityentitieswithdirectcontactwithfamilies)istrainedtodelivertheTriplePsystemofinterventions.Thisworkforceisthenresponsiblefordeliveringtheprogramtoparents.

ProgramTargetsThecommunity-wideversionofTriplePtargetsparentswithchildrenyoungerthaneightyearsofage,andtheinterventionisdeliveredcommunity-widethroughmultipleproviders.

ProgramContentThemultilevelsystemincludesfiveinterventionlevelsofincreasingintensityandnarrowingpopulationreach:

Universal Triple P (Level 1)usesmediaandinformationalstrategiesthat:■ destigmatizeparentingandfamilysupport■ makeeffectiveparentingstrategiesavailabletoallparents■ facilitatehelpseekingandself-regulation

Selected Triple P (Level 2)normalizesparentinginterventionsthrough:■ briefandflexibleconsultationwithindividualparents■ parentingseminarswithlargegroupsofparents

Primary Care Triple P (Level 3)managesdiscretechildbehaviorproblemsthrough:■ fourbriefconsultationsthatincorporateactiveskillstraining■ selectiveuseofparentingtipsheetsoncommonproblemsofyoungchildren■ generalizationenhancementstrategiestoapplyskillstootherareas

Standard and Group Triple P (Level 4) benefitsindicatedpopulationsofchildrenwithdetectableproblemsby:■ teachingparentsavarietyofchildmanagementskills■ combiningprovisionofinformationwithactiveskillstrainingandsupport

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■ teachingparentstoapplyskillstoabroadrangeoftargetbehaviorsinnumeroussettings

Enhanced Triple P (Level 5)isdirectedatfamilieswithadditionalriskfactorsandincludes:■ optionalmodulesonpartnercommunication,moodmanagementandparent

copingskills■ additionalpracticesessionsaddressingparent-childissues

ProgramOutcomesComparedtocontrolcounties,positiveeffectsintheTriplePSystemcountieswereseenforratesof:■ substantiatedchildmaltreatment■ childout-of-homeplacements■ hospitalizationsoremergency-roomvisitsforchildmaltreatmentinjuries

NoteOnlyTripleP,whenimplementedasatotalsysteminacommunity,isbeingcertifiedbyBlueprints.EvaluationsofindividuallevelsofTriplePimplementedalone,suchastheLevel4Standard,Group,orSelf-Directedformats,havenotmetBlueprintscriteria.

ReferencesPrinz,R.J.,Sanders,M.R.,Shapiro,C.J.,Whitaker,D.J.,andLutzker,J.R.(2009).Population-BasedPreventionofChildMaltreatment:TheU.S.TriplePSystemPopulationTrial.PreventionScience,10,1-12.

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Parent-ChildHome

TheProgramModelTheimportanceofParent-ChildinteractionAllchildren’sfirstyearsshouldbefilledwithverbalstimulationtobuildlanguageandliteracyskills.Eachdayshouldbefullofdiscoveryandofferopportunitiestogainnewskillsandlearnnewconcepts.Fosteringverbalinteractionbetweenparentsandtheiryoungchildrenisacriticalcomponentofhealthyandsuccessfuldevelopment(Bruner,1964and1966;Vygotsky1962).Theimportanceofthisinteractionhasbeenfurthervalidatedbythebrainandlanguagedevelopmentresearch(Hart&Risley).FormativeresearchonTheParent-ChildHomeProgram’s1965pilotproject(thenTheMother-ChildHomeProgram)affirmedthatthiscriticalparent-childinteractioncouldbestrengthenedbymodelingreading,play,andconversationforparentsandchildrenintheirownhomes(LevensteinandSunley1968).

Schoolreadiness:BridgingthepreparationgapAcrossthecountry,millionsofchildrenbeginkindergartenunprepared.Theyare“leftbehind”asearlyasthefirstdayofschool.Thesechildrenhavenotadequatelyexperiencedqualityverbalinteractionorbooks.Theyhavenotbeenexposedtoplayandinteractiveexperiencesthatencourageproblem-solvingandappropriatesocial-emotionaldevelopment.Theydonothavethelanguageskillstheyneedtosuccessfullyinteractwiththeirteachersandtheirclassmates.Theymaynotbeabletocontroltheirbehaviorsoremotionsaswellasotherstudents.Theymayhaveheardmorediscouragementsthanencouragements.Withouttheskillstheyneedtosuccessfullyadjusttotheclassroom,theybegintheiracademiccareersbehindtheirpeers.Manyofthesechildrenwillnevercatchup.

TheParent-ChildHomeProgrambridgesthis“preparationgap”byhelpingfamilieschallengedbypoverty,limitededucation,languageandliteracybarriers,andotherobstaclestoschoolsuccesspreparetheirchildrentoenterschoolreadytobeintheclassroom.

Theapproach:Modelingvs.teachingTheParent-ChildHomeProgramutilizesanon-directive,non-didacticapproach,modelingbehaviorsforparentsthatenhancechildren’sdevelopmentratherthanteachingbehaviors.HomeVisitorshelpparentsrealizetheirroleastheirchildren’sfirstandmostimportantteacher,generatingenthusiasmforlearningandverbalinteractionthroughtheuseofengagingbooksandstimulatingtoys.Parentsarenevergivenhomeworkorassignmentstocompletebutareencouragedtocontinuequalityplayandreadingbetweenvisitswiththebooksandtoystheyreceive

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eachweek.The“lighttouch”employedbyParent-ChildHomeProgramHomeVisitorsisnon-intimidatingandempowersparents,allowingthemtopreparetheirchildrenforschoolsuccess,andtakeprideintheircommitmentto,andimpacton,theirchild’seducation.EveryParent-ChildHomeProgramlocalsiteadherestoacarefullydevelopedandwell-testedmodeltoensurehighqualityservicesandconsistentresults:

Site Structure: ■ EachsiteisrunbyaSiteCoordinatorhiredbythelocalpartneragencyand

trainedbyTheParent-ChildHomeProgram’sNationalCenter.■ TheSiteCoordinatorsarethenpreparedtorecruitandtraintheirlocalHome

Visitors.■ Traininginmulticulturalawarenessandtheethicsofhomevisitingare

importantcomponentsoftheParent-ChildHomeProgram’strainingcurriculumforSiteCoordinatorsandHomeVisitors.Respectandunderstandingarecriticalforsuccessfulhomevisitingrelationships.

■ Familiesparticipateinthetwo-yearprogramwhentheirchildrenaretwo-andthree-years-old,completingtheProgramastheyturnfourandtransitionintopre-kindergartenorHeadStart.Achildcan,however,entertheProgramasyoungas16monthsandsomesitesservefamilieswithchildrenupthroughfour-years-oldiftherearenootherpre-schoolservicesavailableinthecommunity.

Home Visit Structure: ■ AHomeVisitorismatchedwiththefamilyandvisitsthemforhalf-an-hour,

twice-a-weekonaschedulethatisconvenientforthefamily.■ Onthefirstvisitofeachweek,theHomeVisitorbringsacarefully-selected

bookoreducationaltoy,thecurricularmaterialfortheweek,whichisagifttothefamily.

■ Inthetwice-weeklyhomesessionswiththeparent(orotherprimarycaregiver)andthechild,theHomeVisitormodelsverbalinteraction,reading,andplayactivities,demonstratinghowtousethebooksandtoystobuildlanguageandemergentliteracyskillsandpromoteschoolreadiness.

■ OverthecourseofthetwoyearsintheProgram,familiesacquirealibraryofchildren’sbooksandalargecollectionofeducationalandstimulatingtoys.

■ EachProgramYearorCycleconsistsofaminimumof23weeksofhomevisitsor46homevisits.

TheParent-ChildHomeProgrammodeldoesallowforsomemodifications,iftheydonotaffectthevalidityofthemodelandareapprovedinadvancebytheNationalCenter,inordertoappropriatelyservefamiliesindiversecommunitiesandawiderangeofcircumstances.

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ReadingRecovery

ReadingRecoveryisaschool-based,short-terminterventiondesignedforchildrenagedbetweenfiveandsix,whoarethelowestliteracyachieversaftertheirfirstyearofschool.Thesechildrenareoftennotabletoreadthesimplestofbooksorevenwritetheirownnamebeforetheintervention.

Theinterventioninvolvesintensiveone-to-onelessonsfor30minutesadaywithatrainedReadingRecoveryteacher,foranaverageof20weeks(abouttwoterms).Theprogrammeisdifferentforeverychild,assessingwhatthechildknowsandwhathe/sheneedstolearnnext.Thefocusofeachlessonistocomprehendmessagesinreadingandconstructmessagesinwriting;learninghowtoattendtodetailwithoutlosingfocusonmeaning.

Childrencompletetheinterventionwhenanindependentobserverjudgesthemasabletoreadandwritewithouthelp,withintheappropriatebandfortheirage.Onaverage,childrenwhohavecompletedhavegonefromtextlevel0toalevel17;thesearebookswithelaboratedepisodesandevents,extendeddescriptions,someliterarylanguage,fullpagesofprint,moreunusualandchallengingvocabularyandlesssupportfromillustrations.Progresscontinuesaftertheintervention,withchildrenmakingonaverageonemonth’sgainwitheachmonththatpasses.

Childrenwhodonotmakethesegainsarereferredbacktotheschoolforlong-termsupport(oneinfive).Howevertheytoomakeconsiderableimprovements,makingoneyear’sgaininsixmonths,andonaveragegoingfromatextlevel0toalevel9;thesearesimplestorybookswithsomerepetitionofphrasepatterns,ideasandvocabulary,severallinesoftextandaround20-40wordsperpage.

ReadingRecoveryisthefoundationinterventionforEveryChildaReader(ECaR).

HistoryReadingRecoverywasfoundedinNewZealandbyMarieClay,basedonherextensiveresearchintoearlyliteracydifficulties

■ In1987MarievisitedCambridgeUniversity,whereshespokeofthedevelopmentofReadingRecoveryinNewZealand.InspiredbyMarie’svisitJeanPrance,anexperiencedprimaryheadteacherandteachereducator,wenttotheUniversityofAucklandtotrainasthefirstUKReadingRecoverytutor(nowknownasteacherleader)

■ In1990thefirstReadingRecoveryteachersweretrainedinSurrey,byJeanPranceandanexperiencedNewZealandtutor,forSurreyEducationAuthority

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■ In1991theInstituteofEducation(IOE)invitedMarietoreturntotheUKwithasmallgroupofNewZealandcolleaguestosetupatutorprofessionaldevelopmentprogramme.SeventutorscompletedthetrainingforlocalauthoritiesinLondonandtheSouthEast

■ In1992thegovernmentcarriedoutathreeyearpilotfundedbyGrantsforEducationSupportandTraining.MariereturnedtotheUKforthefirstyeartosetuptwoparalleltutortrainingcourses,onebasedattheIOEandasecondinSheffield,and24tutorsweretrainedinthefirstyearforlocalauthoritiesacrossEngland.JeanPranceandJuliaDouetilweretrainedasthefirsttrainersfortheUK

■ Bythemid1990sReadingRecoveryhadspreadacrossEnglandandextendedtoschoolsinJersey,Scotland,Wales,NorthernIrelandandtheRepublicofIreland

■ In1995,afterthethreeyearpilotwascomplete,ReadingRecoverybecamelocallyfundedwithgovernmentsupportfornationalcoordinationinEngland

■ ThefirsttutorsforNorthernIrelandweretrainedin1993,forScotlandin1998,andforIrelandandWalesin1999

■ In2003auniversityprofessorfromCopenhagentrainedasaReadingRecoverytrainerattheInstituteofEducationandbeganaredevelopmentofReadingRecoveryintoDanishforimplementationinDenmark

■ InMay2005ReadingRecoverywasincludedintheDEIS(DeliveringEqualityofOpportunityinSchools)ActionPlanfortheRepublicofIreland,withfundingtargetedtochildrenindisadvantagedschools

■ Inearly2005theEuropeanCentreforReadingRecoveryworkedwithcolleaguesfromKPMGFoundationtodevelopEveryChildaReader(ECaR)asanextensionofReadingRecovery

■ InSeptember2005athree-yearECaRpilot,withReadingRecoveryatitscore,wasfundedbyacollectiveofcharitableorganisationsledbyKPMGFoundationandtheDepartmentforChildren,SchoolsandFamilies(DCSF)

■ In2008-11thesuccessoftheECaRpilotledtotheprogrammebeinggovernmentfundedinathree-yearrolloutacrossEngland

In2011governmentfundingforECaRwasplacedintoDedicatedSchoolsGrantforthefullthreeyearsofthe2011-14ComprehensiveSpendingReview,withtheintentiontoshifttheECaRstrategytoamarket-ledmodelProgramDescriptionReadingRecovery®isashort-termtutoringinterventionintendedtoservethelowest-achieving(bottom20%)first-gradestudents.ThegoalsofReadingRecovery®aretopromoteliteracyskills,reducethenumberoffirst-gradestudentswhoarestrugglingtoread,andpreventlong-termreadingdifficulties.ReadingRecovery®supplementsclassroomteachingwithone-to-onetutoringsessions,

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generallyconductedaspull-outsessionsduringtheschoolday.Tutoring,whichisconductedbytrainedReadingRecovery®teachers,takesplacedailyfor30minutesover12–20weeks.

ResearchFourstudiesofReadingRecovery®meetWhatWorksClearinghouse(WWC)evidencestandards,andonestudymeetsWWCevidencestandardswithreservations.Thefivestudiesincludedapproximately700first-gradestudentsinmorethan46schoolsacrosstheUnitedStates.3

Basedonthesefivestudies,theWWCconsiderstheextentofevidenceforReadingRecovery®tobemediumtolargeforalphabetics,smallforfluencyandcomprehension,andmediumtolargeforgeneralreadingachievement.Effectiveness

ReadingRecovery®wasfoundtohavepositiveeffectsonalphabeticsandgeneralreadingachievementandpotentiallypositiveeffectsonfluencyandcomprehension.

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Parent–ChildInteractionTherapy(PCIT)

WhatisPCIT?Parent-ChildInteractionTherapy(PCIT)isanempirically-supportedtreatmentforconduct-disorderedyoungchildrenthatplacesemphasisonimprovingthequalityoftheparent-childrelationshipandchangingparent-childinteractionpatterns.InPCIT,parentsaretaughtspecificskillstoestablishanurturingandsecurerelationshipwiththeirchildwhileincreasingtheirchild’sprosocialbehavioranddecreasingnegativebehavior.Thistreatmentfocusesontwobasicinteractions:ChildDirectedInteraction(CDI)issimilartoplaytherapyinthatparentsengagetheirchildinaplaysituationwiththegoalofstrengtheningtheparent-childrelationship;ParentDirectedInteraction(PDI)resemblesclinicalbehaviortherapyinthatparentslearntousespecificbehaviormanagementtechniquesastheyplaywiththeirchild.

Parent–childinteractiontherapy(PCIT)isaformofpsychotherapydevelopedbySheilaEybergforchildrenages2–7andtheircaregivers.Itusesauniquecombinationofbehavioraltherapy,playtherapy,andparenttrainingtoteachmoreeffectivedisciplinetechniquesandimprovetheparent–childrelationship.PCITevolvedfromConnieHanf’stwo-stageoperantmodelofparenting.

StagesofPCITAlthoughPCITisdividedintotwostages,relationshipdevelopment(child-directedinteraction)anddisciplinetraining(parent-directedinteraction),therearealsothreedistinctassessmentperiods(pre-treatment,mid-treatment,post-treatment).

Child-directedinteractionThechild-directedinteractionportionofPCITaimstodevelopalovingandnurturingbondbetweentheparentandchildthroughaformofplaytherapy.Parentsaretaughtalistof“dos”and“don’ts”tousewhileinteractingwiththeirchild.TheywillusetheseskillsduringadailyplayperiodcalledSpecialTime.

DRIP/PRIDEskillsParentsaretaughtanacronymofskillstouseduringSpecialTimewiththeirchildren.Althoughtheacronymvariesfromtherapisttotherapist,itisgenerallyeither“DRIP”or“PRIDE.”DRIPstandsforthefollowing:

D–DescribeR–ReflectI–ImitateP–Praise

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Likewise,PRIDEstandsforthefollowing:

P–PraiseR–ReflectI–ImitateD–DescribeE–Enthusiasm

MostPCITtherapistscurrentlyusePRIDEbecauseDRIPisawkwardandthe“E”supportsthevalueandimportanceofparentalpositiveaffectiveengagementinparent–childinteractions.

Theseacronymsareremindersthatparentsshoulddescribetheactionsoftheirchild,reflectuponwhattheirchildsays,imitatetheplayoftheirchild,praisetheirchild’spositiveactions,andremainenthusiasticthroughoutSpecialTime.

Parent-directedinteractionTheparent-directedinteractionportionofPCITaimstoteachtheparentmoreeffectivemeansofdiscipliningtheirchildthroughaformofplaytherapyandbehavioraltherapy.Itcanbeusedwithmaltreatedchildren.

UsedPCIThasbeenusedwithabusivefamilies.PCIThasbeenusedwithoppositionalchildren.Parent–childinteractiontherapyisamodelthathasdemonstratedsuccesswithchildrenwithoppositionaldefiantdisorderthathasrecentlybeenappliedtochildrenwithautism.Currently,alotofresearchhasbeendoneonhowPCITcanbeusedtokeepdifficultparentingpopulationsintreatment.ResearchshowsthatskillslearnedinPCITtrainingsessionsgeneralizetothehome.

EfficacyPCIToutcomeresearchhasdemonstratedstatisticallyandclinicallysignificantimprovementsintheconduct-disorderedbehaviorofpreschoolagechildren:Aftertreatment,children’sbehavioriswithinthenormalrange.StudieshavedocumentedthesuperiorityofPCITtowaitlistcontrolsandtoparentgroupdidactictraining.Inadditiontosignificantchangesonparentratingsandobservationalmeasuresofchildren’sbehaviorproblems,outcomestudieshavedemonstratedimportantchangesintheinteractionalstyleofthefathersandmothersinplaysituationswiththechild.Parentsshowincreasesinreflectivelistening,physicalproximity,andprosocialverbalization,anddecreasesinsarcasmandcriticismofthechildaftercompletionofPCIT.Outcomestudieshavealsodemonstratedsignificantchangesonparents’self-reportmeasuresofpsychopathology,personaldistress,andparentinglocusofcontrol.Measuresof

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consumersatisfactioninallstudieshaveshownthatparentsarehighlysatisfiedwiththeprocessandoutcomeoftreatmentatitscompletion.

CosteffectivenessParent–childinteractiontherapyhasbeenfoundtobeacosteffectiveapproach.Thewaythatcosteffectivenesswasmeasuredwasbycomparingratiooftreatmentcoststobehaviorgains,asmeasuredbyclinicallysignificantimprovementontheCBCL(reductionrangingfrom17–61%).

ForasummaryofPCITandinformationaboutthefutureresearchdirectionsofPCITsee:

Zisser,A.,&Eyberg,S.M.(2010).Treatingoppositionalbehaviorinchildrenusingparent-childinteractiontherapy.InA.E.Kazdin&J.R.Weisz(Eds.)Evidence-basedpsychotherapiesforchildrenandadolescents(2nded.,pp.179-193).NewYork:Guilford.

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FathersReadingEveryDay(FRED)

FathersReadingEveryDay(FRED)isanaward-winningUSfamilyliteracyprogrammeheldatlibraries,earlyyearscentres,nurseries,primaryschools,churchesetc.

Fathersreceiveapackcontainingareadinglog,tipsforreadingaloudandrecommendedbooklists.Duringfourweeksthedadsdocumenttimespentreadingtotheirchildrenandthenumberofbooksread.Collaboratingwithapubliclibraryencouragesfatherstosignup,familiarizesthemwiththelibrary,andprovidesaccesstofreebookstouseintheprogramme,aswellasbooksinlanguagesotherthanEnglish.

Morethan7,000fathershaveparticipatedsofarandstatisticallysignificantincreasespre/postinterventionincludetimespentreadingtochildren,numberofbooksread,levelofinvolvementinchildren’seducation,amountandqualityoftimespentwithchildren,andlevelofsatisfactionwiththefather-childrelationship.Thepercentageoffathersreadingtotheirchildrenthreeormoretimesperweekincreasedfrom53%to80%.

Over6,000fathersandchildrenfrom77TexasCountieshaveparticipatedintheFREDprogramsince2002.Outcomesfromtheprogramareverypositive.Participantswhocompletedtheprogramaveragedapproximately9hoursofreadingtimewiththeirchildrenandreadnearly40booksoverthecourseofthefour-weekprogram.

Resultsfromarecentevaluationstudyof300participantsdemonstratedsignificantimprovementsinmanyareas,includingtheamountoftimefathersspentreadingtotheirchildren,numberofbooksreadduringatypicalweek,levelofinvolvementintheirchildren’seducation,amountandqualityoftimespentwiththeirchildren,andlevelofsatisfactionwiththefather-childrelationship.Therewasalsoasignificantincreasefrompretopostinthenumberoffathersobtainingalibrarycard.OthersignificantfindingsfromFREDparticipantsinclude:

■ 61.4%reportedthatFRED“IncreasedthetimeIspentwithmychild.”■ 58.7%reportedthatFRED“ImprovedthequalityofthetimeIspendwithmy

child.”■ 57.2%reportedthatFRED“Helpedmebecomemoreinvolvedinmychild’s

education.”■ 66.2%reportedthatFRED“Increasedmysatisfactionlevelasaparent.”■ 70.3%reportedthatFRED“Improvedmyrelationshipwithmychild.”

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Inopen-endedresponses,manyfathersindicatedthattheynotedimprovementsintheirchild’svocabulary,readingability,andinterestinbooksasaresultofparticipatinginFRED.Somefathersevennoticedimprovementsintheirownliteracyskills.

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TimetoRead

TimetoReadisapairedreadingprogrammeengagingbusinessvolunteersonaone-to-onebasiswithKeyStagetwochildrentodevelopthemsociallyandemotionallyaswellasenhancingtheirliteracyskills.Theprogrammewasestablishedin1999andwasinitiallychampionedbyNorthernIrelandElectricity.theprogrammewasevaluatedbyQueensUniversityusingarandomcontrolgroupdemonstratingitseffectiveness.

TimetoReadisoneofthreeTimeto…programmesdevelopedbyBusinessintheCommunity,inpartnershipwiththelocalEducationandLibraryBoards,tohelpimproveliteracy,numeracyandcomputingskillsinlocalprimaryschools.Theotherprogrammesare:Time2CountandTimetoCompute,the‘Timeto’CompaniessupporttheirstafftovolunteeranhourperweektoworkalongsideKeyStageTwochildren(eight—tenyearolds).

Currently48ofNorthernIreland’sleadingcompaniesparticipateonthe‘Timeto’programmesworkingin63schoolsacrossNorthernIreland,includingOldWarrenandKillowenPrimarySchools.

Suggestedbenefitstothecompanyinclude:■ developsstaffconfidence■ self-esteemandcommunicationskills■ motivatesstaffandenhancesteamwork■ raisesprofileinthelocalcommunity■ buildspartnershipswithlocalschools

Suggestedbenefitstotheschoolsinclude:■ providesaninsightintothebusinessworld■ motivatesanddevelopschildrenacademicallyandsocially■ introduceschildrentoapositiverolemodelfromtheworldofwork■ enableschildrentoworkonaone-to-onebasisimprovingcommunicationskills

Time2Count(notyetrobustlyevaluated)alsofocusesonchildreninPrimary5—Primary7.Theaimofthisprogrammeistomotivatechildrentoenjoymathsandtorecogniseitasaneverydayactivity.Volunteersplaymathbasedgameswiththechildrentoconsolidatemathslearningintheclassroom.NorthernBankleadthisnumeracyprogramme.

TimetoCompute(notyetrobustlyevaluated)hasbeendevelopedtohelpbridgethedigitaldivideinlocalprimaryschools.Businessvolunteersworkonaone-to-oneprogrammewithchildrenaged8-10helpingthemtobecomeliterateinInformation

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andCommunicationsTechnology(ICT).HPhavesupportedtheTimetoComputeprogrammefromitslaunch.

TheCommitmentCompaniesinvolvedagreetoreleasestaffforonehouraweektovolunteerinalocalschool.Initialcommitmentisforoneyearwiththeoptionofextendingandmanyofourvolunteersarenowintheirfifthandsixthyear.CompaniesinvolvedinTimetoReadandTimetoCountalsoagreetocontributefinanciallytohelpprovideresourcesfortheschool(eitherbooksormathsmaterials).

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APPENDIX FOUR

Early Intervention Sites in the UK and Ireland

Nottingham

youngballymun

WestTallaghtCDI

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NottinghamEarlyIntervention

TheEarlyInterventionProjectsAnumberofinnovativedeliveryprojectshavebeentrialledaspartofthebroaderEarlyInterventionProgramme.Theprojectsincludednewworkandlearningfromexistingwork,andhavefocusedontacklingintergenerationalcyclesofdeprivationandcomplexproblemswithinNottingham,drivingtheProgramme’svision.

TheprojectsweredevelopedbythesixThemePartnershipsofOneNottingham,requiringjoined-upworkingtotacklecross-cuttingissues.

■ CrimeandDrugsPartnership• DrugAwareAward• StrongerFamiliesProject• AdultOffendingTeamFamilyInterventionProject

■ Children’sPartnership• DevelopingNaturalLearning• RaisingAspirations UsingCustomerInsighttoEnableEffectiveEngagement PuttingFamiliesattheCentre 11-16LifeSkills iRise FamilyWelfare-ReducingPersistentAbsence

■ HealthandWellbeingPartnership• FamilyNursePartnership• ActiveFamilies

■ NeighbourhoodPartnership• SanctuaryInitiative

TheseprojectsconcludedinMarch2011,withlearningfromthemostsuccessfulelementseitherbeingsustainedthroughmainstreamsystemsorbeingfurtherdevelopedandtested.Thiswillenablethedevelopmentofmorerobustevidenceoftheimpactofthesemodels.

Elementsofthefollowingprojectsarecontinuing:

■ StrongerFamiliesProject■ RaisingAspirations■ 11-16LifeSkills

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■ DrugAwareAward■ FamilyNursePartnership■ ThebroaderFamilyInterventionProject■ ActiveFamilies■ SanctuaryInitiative

Moreinformationwillbeavailablesoonontheseapproachesgoingforward.

CRIMEANDDRUGSPARTNERSHIP

DRUGAWAREAWARDSettingarobuststandardofexcellenceindrugseducationandpolicywithinschoolsandthecommunity.ProvidinganidentifiablebrandthatcanbeusedtodriveforwardthestandardofdrugsandalcoholeducationinNottinghamCityto:

■ EncourageschoolstoreachaboveandbeyondtheHealthySchoolsstandard■ Raisetheprofileofdrugseducationforpupils,parentsandthecommunity■ Ensureeffectivescreeningofdruguseandrisksofdruguse■ Ensureeffectivetargetedinterventionsforthosepupilsassessedas‘atrisk’

throughimprovedreferralpathwaystospecialistservicesandthroughembeddingtargetedinterventionswithinaschoolsettingwithappropriatelytrainedstaff

■ Helpparentstobemorefullyengaged(inbothpolicysettinganddrugseducation)

■ Increasepartnershipworkingwiththeschoolcommunity,NeighbourhoodBeatTeamandTradingStandards

■ InvolvepupilsintheCity-widedrugseducationpolicysetting■ Increasetheskillbaseofkeystaffwithinschools

STRONGERFAMILIESPROJECTStrongerFamilies,deliveredbyWomen’sAid,offersa12-weekprogrammeoffocusedgrouptherapeuticsessionsformothersandchildren(aged4-16)whohavebeenaffectedbydomesticabuse,oncetheperpetratorhasnowleftthefamilyhome.

Mothersandchildrenpartakeinseparategroupsessionswhichrunconcurrently.Thesessionsprovidebothmotherandchildwithasafespaceandtheopportunitytodisclose,processandunderstandtheabusethattheyhaveexperiencedorwitnessed.Mothersaresupportedtobetterunderstandtheirchild’sbehaviour,relatingtotheabuse.

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Theprojectaimstostoptheintergenerationalimpactofdomesticabusebysupportingfamiliestorecoverfromtheabuseanddecreasethelikelihoodofrepeatincidents.

FromAugust2009toDecember2010,therehavebeentwodomesticviolencerelatedrepeatincidentswithinthefirst26families(7.7%)whohavecompletedtheprogramme;significantlylowerthanthenationaldomesticviolencerepeatincidentrateof44%.

Schoolshavereportedimprovementsinthebehaviour,confidenceandinteractionsofyoungpeopleintheprogramme.Therehasbeenincreasedschoolattendanceofchildrenwherethishadpreviouslybeenaproblem.

ADULTOFFENDINGTEAMFAMILYINTERVENTIONPROJECTReducingtheriskofoffendingandentryintothecriminaljusticesystembychildreninthefamiliesofadultoffenders,particularlypersistentandprolificoffenders.Theprojectprovidesstabilityofaccommodation,supporttoreducesubstancemisuse,helptoobtaintrainingandemploymentforrelevantfamilymembersandtoincreasetheacademicsuccessofchildreninthefamily.Theprojectworksholisticallyandintensivelywiththefamiliesofadultoffenderswhoareeitherthemselvesparentsorareoldersiblingslivingwithinorimpactinguponanexistingfamilyunitinordertobreakthecycleofintergenerationaloffendingandreducethecriminalinfluencethatadultoffendershaveuponthechildrenwithwhomtheyhavecontact.Intensivesupportofatleastsixmonthsisprovidedtothefamiliesusing,whereappropriate,a‘coercive’modelofengagement.

Children’sPartnership

DEVELOPINGNATURALLEARNINGTriallingtheForestSchoolsapproachwithsixschoolsintheCity,encouragingchildrentoexploretheirlocalenvironmentanddevelopreasoningskills,analyserisksandpredicttheconsequencesoftheiractions.Theseven-weekoutdoorlearningprogrammepromotesteamwork,listeningskills,risktaking,tooluse,safetyawareness,cooperationandindependence.

Theactivitiescreateopportunitiesforemotional,socialandbehaviouraldevelopment,improvingoutcomesthroughimprovingbehaviourandhigherlevelthinkingskills.Theprojectaimstoembedthelearninginschoolsandprovideopportunitiesforstaffwithintheschooltosharelearningandbestpracticewithotherschoolsandcolleagues.

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Childrenhavereportedthattheprojectincreasedtheirconfidence,socialskillsandtheirabilitytomakebetterdecisionsandhashelpedthemtolearnwhichrisksarewisetotake.Parentsandteachershavealsogivenpositivefeedbackandtherehavebeennoexclusionsinthesegroupssincetheprojectstarted.

RAISINGASPIRATIONSDevelopingandtriallinganaspirations-raisingtoolkit,whichincludesauniqueaspirationsassessmenttool,apackageofinterventionsdesignedtoraiseaspirationandaprocessfordevelopinganaspirationsfocus.AspirationDevelopmentOfficersaredeliveringinterventionsinschoolsandresearchingandplanningfutureinterventions.

Theassessmenttoolisthefirstprimary-ageappropriate,aspirationassessmenttoolnationally.Itallowsschoolstotakeanearlyinterventionapproachtounderachievementandnegativebehaviours.Childrencannowbeidentifiedasbeing‘atrisk’ofmakingnegativedecisionsasaresultoflowlevelsofaspiration.Previouslytherehasbeennoassessmentmechanism.

Earlyindicatorsofimpactfromtheinterventionsbeingtrialledarealreadybeingreportedbyteachers,includingsignificantimprovementsintheconfidence,attitude,behaviourandengagementofpupilsinthecohortwhohadbeenidentifiedashavingverylowlevelsofconfidenceandaspirationatthestartoftheproject.

Theprojectisalsoshowingpositiveimpactonattendanceandattainmentofthosepupilsinvolvedintheproject.Twoschoolshavealreadyreportedthatthecohortreceivingaspiration-raisingsupport,performedwellaboveexpectationintheirSATs,withtwootherschoolsreportingresults10%higherthanpredictionsandinoneschoolanumberofindividualpupilshavemadeup13sub-levelsofprogress,comparedtothepredictedsix.

ItisplannedthatthetoolkitwillbeusedacrossthewiderChildren’sWorkforce.

USINGCUSTOMERINSIGHTTOENABLEEFFECTIVEENGAGEMENTWITHCHILDRENANDTHEIRPARENTSResearchhasbeenundertakenusingExperian’sCustomerInsightdatabase,whichprovidestheunderstandingofneedwithinNottinghamCitythatisrequiredtodelivertherightservicestotherightchildren,youngpeopleandfamilies,throughtherightfacilityattherighttime.Theinformationisbeingusedtoreengineerservicessothatserviceprovisionmeetsneedthrough:

■ Understandinglevelsofneedforserviceswithineachlocality

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■ Understandingthechildrenandfamilieswhouseandneedservices,withservicesbeingdeliveredinthemostappropriate,accessibleandeffectiveway

■ Communicationwiththetargetgroupsbeingundertakeninthemosteffectiveway

Effectivelyunderstandingneedwithinlocalitieswillenablecomparisonofserviceprovision,serviceuptakeandneedandthereforeidentificationofefficiencyofservices.Thiswillenablethetargetingofworkatindividualsorfamilieswhoareverylikelytohavedifficultiesorimpairedoutcomeswithouteffectivesupportorintervention.

Furtherdetailoncustomerinsightcanbefoundathttp://www.nottinghaminsight.org.uk/

PUTTINGFAMILIESATTHECENTRE(PARTOFTHECOLLABORATIONFORLEADERSHIPINAPPLIEDHEALTHRESEARCHANDCARE,NOTTINGHAMSHIRE,DERBYSHIREANDLINCOLNSHIRESTRAND[CLAHRCNDL])AnationalNHSandUniversityofNottinghamcollaboration.NottinghamisapartnerintheNDLstrandoftheCLAHRC.Thefocusoftheprojectistranslatingcurrentacademicresearcharoundmentalhealthservicesandchildrenandyoungpeopleintoworkingpracticethroughtwo‘DiffusionFellows’,actingaschangeagentsacrosstheCity.Theworkisexploringtheimpactofuncoveringparentalmentalhealthneedsinordertobettermeettheneedsofthechildandislookingintotheorganisationalbarrierstoajoined-upmodelofadultandchildmentalhealthprovisionintheCity.Proposalstotrialajoined-up,familyfocusedmodelarebeingdeveloped.

11-16LIFESKILLSThe11-16LifeSkillscurriculumprogrammeisdesignedtosupportthedevelopmentoftheskillsandknowledgeneededforyoungpeopletomakethebestlifedecisions,increaseconfidencelevelsandraiseaspirations.

Therearecurrentlyjustunder3000youngpeopleaccessingtheprogrammewithinsixsettings.Atrainingprogrammeandtoolkitforschoolstodelivertheprogrammeisbeingdeveloped,withtheaimofrollingitouttoallsecondarysettingsintheCityearlyin2011.

ThetoolkitwillincludeanumberofPlanningFrameworkmodelsandthenewSEAC(SocialEmotionalAspectsofChange)resourcematerials,whichisbasedonSEAL(SocialEmotionalaspectsofLearning,usedinallprimaryschools)focusingonchangingnegativebehaviours.

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TheNationalFoundationforEducationalResearch(NFER)haveconductedanindependentevaluationoftheproject;theinitialconsultationanddesignprocess,whichinvolved550studentsand218staff,wascitedasexcellentpractice.Theconsultationfoundthatstudentsfeelthatthereisaneedformorecoverageofmentalhealthissues,financialcapability,sexualrelationships,parentinganddemocracy.

Sofar,thefollowingimprovedoutcomesforchildrenandyoungpeoplehavebeendemonstrated;

■ Improvedconfidencetodiscusssensitivetopicswithteachersandformulateandexpressopinions

■ Improvedskilldevelopment,knowledgeandunderstandingoftopicareas■ Studentsreportedthattheyfeltbetterinformedandequippedtomake

decisionsaboutsexandrelationshipsandriskawareness■ Studentshaveimprovedawarenessofhowtoseekhelp,forexample,howto

accesssupportfromtheschoolnurseaboutcontraceptionandSTIs.

Staffhavealsoreportedanincreasedconfidenceinteachingsensitivetopics.

IRISEiRiseworkswithagroupofchildrenandyoungpeopleinKeyStages2-4(ages8-16)inNottinghamCityschools,whoareinthecareoftheLocalAuthority.Theprojectaimsistoincreasetheyoungpeople’sattainmentandaspirationanddeveloptheirsocialandemotionalresilience.Thiswillbeachievedthroughindividuallearningsupport,motivationalpersonaldevelopmentprogrammesfocusingongoalsettingandselfesteemandaspiration-raisingeventstoinformyoungpeopleaboutpost-16educationalopportunities.

ApositivepsychologydevelopmentprogrammehasbeendeliveredtoanumberofyoungpeopleinthecareoftheLocalAuthority.Participantshavereportedthatthecourseisusefulforanumberofareasoftheirlife;mostly‘takingcareofmyself’,‘takinganactivepartinFurtherEducation(FE)’andpersonalgoalsetting-94%saythattheywouldrecommendit.

PartnershipshavebeendevelopedwithAimingHigher,NewCollegeNottinghamandNottinghamCityCouncilSportandLeisureServicestodeliveraspiration-raisingeducationalopportunitiesawarenessevents.Allyoungpeopleinvolvedintheprojecthavereportedthattheseeventshavemadethemawareoftheopportunitiesavailabletothemandthattheyarenowplanningtoaccesspost-16education.

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FAMILYWELFARE-REDUCINGPERSISTENTABSENCEImprovingtheuseofresourcestotacklethecausesofabsenceinschools.Theprojectfocusesontheearlystageinthecycleofabsence,particularlyinprimaryschoolsandYearsSevenandEightofsecondaryschools,aswellasfocusingonfamilieswithyoungchildrenwhohavepoorattendingoldersiblings,inordertobreaktheintergenerationalcycleofnon-attendance.

Asignificantdecreaseinpersistentabsencehasbeendemonstrated.AcrossthesixschoolsspecificallytargetedbytheDepartmentforEducation,betweenSeptember2009andMarch2010,therewasadecreaseof133casesofpersistentabsence;areductionof26%.Summerterm2009statisticsshowareductionof23.5%acrossallSecondaryschoolsandAcademies,and44.9%acrossPrimaryschools.

IndicatorsalsoshowthatpersistentabsenceistackledandresolvedmorequicklywiththeuseoftheLeadProfessionalbudget,astheamountofchildrenoryoungpeoplewhoarepersistentlyabsentformorethanonetermhasshownadecreasingtrendsincethestartoftheproject,from46%inAutumn2008/09to23%inAutumn2009/10.

HEALTHANDWELLBEINGPARTNERSHIPFAMILYNURSEPARTNERSHIPProvidingsupporttofirst-timepregnantteenagersandtheirpartner,inordertopositivelyimpactontheirparentingskillsandoutcomesforthemandtheirchild.

Theprogrammehasdemonstratedimprovedmentalhealthandparentingskills,increasedbreastfeedingandimmunisationtake-upratesandreducedsmokingrates.

AnecdotalevidenceindicatesthatissuesareidentifiedatanearlierstageandthereforeSocialCaresupportismoreeffective.

Nottinghamispartofaninternationaltrialofamodelfordeliverytogroups(currentlyone-to-one)andislookingintothecostandimpactofthis.

Theprojectreceivedadditionalfundingtoexploreengagementoffathersintheirchild’slife.Findingsarenowreadyfordissemination,withkeymessagesincludingthatsomemendonotengagewiththeservicebecausetheybelieveittobejustformothers;howeverthedepthoftherelationshipthenursedevelopswiththefatheriscrucialinachievingsuccessfuloutcomesforthechild.

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ACTIVEFAMILIESIncreasingopportunitiesforfamiliestoengageinphysicalactivity,regularlytogether.Aimingtohalttheriseinobesityandreducehealthinequalitiesandcardiovasculardisease.AvarietyofphysicalactivityandsportsessionsareprovidedeachweekataselectionofleisurecentresacrosstheCity.

310families(1073individuals)haveengagedintheprojectsincethelaunchinMay2009.12%ofthesefamilieshavealreadystartedtoshowcontinuedengagement(5sessionsormoreattended).63%ofthoseengagedarefromareaswithlowlevelsofphysicalactivityandhighlevelsofchildobesityanddeprivation.

Theprojectalsoactsasauniquereferralpathwayforchildhoodobesitybetweentheagesoftwoandfour,andalsoapathwayfromtheGo4It!project.

NEIGHBOURHOODPARTNERSHIPTHESANCTUARYINITIATIVEProvidingadditionalsecuritytothehomesofsurvivorsofdomesticabuse,oncetheperpetratorhasbeenremoved,andapackageoffloatingsupport,includinghomevisits,foruptosixmonths.Theprojectenablesfamiliestostayintheirownhomeandsocialnetworkandthechildrentostayintheircurrentschool.

Evidenceofimpactisdemonstratedbythereducedrateofrepeatdomesticviolenceincidentswithinthecohort(30%),muchlowerthanthenationalrepeatincidentrateofdomesticviolence(44%).Therehasalsobeenareducedprevalenceofhomelessnessapplicationsduetodomesticviolence(NottinghamCityHousingAid)-thishasgonefrombeingthethirdmostprevalentreasonin2006/07tothefifthin2008/09.

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youngballymun

youngballymunisoneofthreeprojectsestablishedthroughthePreventionandEarlyInterventionProgramme,jointlysupportedandresourcedbytheOfficeoftheMinisterforChildrenandYouthAffairsintheRepublicofIrelandandtheAtlanticPhilanthropies.

ThePreventionandEarlyInterventionProgrammeforChildrenwasestablishedbyGovernmentinFebruary2006tosupportandpromotebetteroutcomesforchildreninareasdesignatedasdisadvantaged,throughmoreinnovation,effectiveplanning,integrationanddeliveryofservices.

TheProgrammetargetsthreegeographicareasinwhichthereisevidenceoftheneedforearlyintervention-Ballymun,TallaghtWestandDarndale.Thepurposeoftheprogrammeistosupportthedevelopment,implementationandevaluationofstrategiesforchildrenatlocalleveldrawnupbythestatutory,voluntaryandcommunityagenciesoperatingintheareasconcerned.TheProgrammeprovidesfortheintroductionandevaluationofarangeofintegratedinterventionsforchildrenandtheirfamiliesandtestiftheymakeapositivedifferencetochildren.

Thefocusoftheprogrammeisonsupportinginterventionswhichfitwithnationalpolicyobjectivesandhavebeendevelopedinconjunctionwiththelocalcommunity.Learningandevaluationareimportantcomponentsoftheprogrammeandindividualservices,areaprojectsandtheoverallprogrammewillbesubjecttoongoingandrobustreviewandevaluation.

TheOMCYAhaspartneredwiththeAtlanticPhilanthropiesinfundingthisprogrammeandatotalfundofupto€36,000,000isavailableacrossthethreeprojects.GovernmentandtheAtlanticPhilanthropieswillprovide€18millioneachinfunding.

youngballymun,theChildhoodDevelopmentInitiative,TallaghtandPreparingforLifeNorthsidePartnershiptogetheraretheprojectsthatmakeupthePreventionandEarlyInterventionProgramme.ResearchandplanningonpreventionandearlyinterventionmeasuressponsoredbyAtlanticPhilanthropies,hadbeenundertakenintheseareasandtheywereconsideredtobeinanexcellentpositiontotestnewmodelsofservicedelivery.Ifthesemodelsprovesuccessful,theresultsoftheseprojectsmayprovidethebasisforenhancedresourceallocationprocessesandpolicychanges.

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TheoverallprogrammeisbeingmanagedbytheOfficeoftheMinsterforChildrenandYouthAffairsonbehalfoftheGovernment.Approvalhasbeengiventofundallthreeprojects2007-2011/12.

WestTallaghtChildDevelopmentInitiative

IntroductionTheChildhoodDevelopmentInitiative(CDI)beganasaplanninginitiativein2003tosupportbetteroutcomesforchildreninTallaghtWest.Aconsortiumof23membersrepresentingcommunityleaders,residentsandprofessionalslivingandworkinginTallaghtWestdevelopedtheoutcomes-focused10-yearstrategy‘APlaceforChildren’.Basedonthislong-termstrategy,adetailedimplementationwasagreedfor2007-2011,againstwhichamajorinvestmentof€15millioneurowasmade,co-fundedbytheDepartmentofChildrenandYouthAffairs,throughthePreventionandEarlyInterventionFund,andTheAtlanticPhilanthropies.

MissionThemissionofWestTallaghtCDIis“WewholiveandworkinTallaghtWesthavehighexpectationsforallchildrenlivinginourcommunities.Wewantourchildrentolovewhotheyareandtobecherishedirrespectiveofsocialbackground,culturaldifferencesandcountryoforigin.Weseeeverychildandeveryfamilybeingprovidedwithsupport,opportunitiesandchoicestomeettheseexpectations.Weseethewholecommunityowningresponsibilityforthequality,beautyandsafetyofthelocalenvironment.Weseechildrenencouragedandcherishedbythewholecommunity.”

QualityServices,BetterOutcomesWorkbooktheCDIhaverecentlypublished‘QualityServices,BetterOutcomes’whichprovidesapracticalresourceforfrontlinestaff,servicemanagersandorganisationsthatarecurrentlyimplementingorintendtoimplement,evidence-basedprogrammesandservicesforchildrenand/ortheirfamilies,drawingonresearchexamplesofbestpractice.

TheCDIProgrammes■ EarlyYearsService■ DoodleDenProgramme■ Mate-TricksProgramme(hasnowbeenstoppedfollowingpoorevaluation

results)■ HealthySchoolsProgramme■ CommunitySafetyInitiative■ QualityEnhancementProgramme■ SafeandHealthyPlace

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■ RestorativePractice■ RestorativePracticeSchedule2011■ CommunityCoachingProgrammeTheirfivemainprogrammesaresubjecttoRCTevaluationsandshouldbeavailableshortly.

GovernanceTheWestTallaghtCDIgovernancestructuresincludethefollowing:■ CDIBoard■ CDIImplementationSupportGroup■ ExpertAdvisoryCommittee■ FinanceandRiskSubCommittee■ ExecutiveSubCommittee■ CommunitySafetyInitiativeSteeringCommittee■ HealthySchoolsSteeringCommittee■ SafeandHealthyPlaceSteeringCommittee■ RestorativePracticeManagmentCommittee

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