Children's Health and Development: Approaches to Early Identification and Intervention

• Authors: Frank Oberklaid, Gillian Baird, Mitch Blair, Edward Melhuish, David Hall, Archives of Disease in Childhood, (December 2013)

The article makes the case that services and programmes are best delivered within a framework of progressive universalism - a universal basket of services for all children and families, with additional support to address additional needs.

Strategies for prevention and intervention

Preconception intervention can reduce disabling conditions with a biological basis, but genetic factors may account for some specific developmental difficulties. Avoidable environmental factors such as smoking in pregnancy, can contribute to these difficulties. However, there is also compelling evidence of the relationship between child developmental outcomes and the parents' social backgrounds, income and education, grouped together as socio-economic status (SES). This suggests that adverse outcomes aren't inevitable and appropriate intervention through influence of the family, family support programmes, early child education and care and early detection of developmental and behavioural problems can reduce the risk of poor outcome in childhood and adult life.

Family support programmes

Children from disadvantaged communities are at greater risk of developmental vulnerability at school entry when compared with children from higher SES families. The magnitude of risk may be proportional to the number of risks present. These include teenage motherhood, low maternal education, physical problems, antisocial behaviour and unemployment. This may affect a child's neuroendocrine function leading to mental and behavioural problems and physical problems. Suboptimal parenting may be the link with these risk factors as quality of a child's experience plays a crucial role to a child's development. Positive parenting can redress the potential negative effects of poverty or family disadvantage.

Intensive support programmes are available for parents who have difficulty in providing a nurturing environment for their children. There are challenges present in engaging parents, stability of staff, training, supervision and the intensity and duration of the programme. Therefore, family support programmes are most effective when linked to high-quality early child education and care (ECEC).

Early child education and care

General population studies from the USA, England and Denmark indicate that the quality of universal preschool is critical for longer-term beneficial effects. A meta-analysis of 125 studies also concluded with similar results that preschool was associated with substantial benefits for cognitive and socio-emotional outcomes. Part-time ECEC from age two or younger can also be beneficial for disadvantaged children. High-quality ECEC should be provided to disadvantaged children as they have the most to gain. The evidence also indicates universal access has universal benefit. Access to ECEC for 15 hours a week should be universal for children from the age of three and arguably from the age of two years old. Universal high-quality ECEC may be regarded as an essential part of the infrastructure for the social and economic health of a nation, a view supported by World Health Organisation, United Nations, Organisation for Economic and Co-operation and Development and the European Commission.

Early detection of developmental and behavioural problems

Cultural and language barriers, social circumstances or depression can act as barriers to the capacity for parents to recognise problems and seek help. Screening for developmental and behavioural problems can help detect issues early. However, screening tests cannot detect the complexity of developmental problems which exist on a continuum whilst screening test would simply distinguish between having and not having the target disorder. Opinion in the UK and Australia is that they do not fulfil the scientific criteria for a whole population screening programme. Therefore, other strategies are needed to detect problems in early intervention. The role of early years practitioners and mental health, education and health care professionals to work collaboratively may play a crucial role in this.

Universal service

This article argues that a universal service facilitates the engagement of all parents across the range of socio-economic status, avoids risk of stigmatisation as was found with Sure Start programmes in the UK. It provides a structure to facilitate the identification of emerging problems and to enable subsequent access to expert assessment and care when parents or professionals have particular concerns about a child.

The authors do point out that within such a policy of progressive or proportionate universalism, the allocation of scarce resources between universal provision and targeted interventions for those with higher needs will inevitably be challenging.

Implications for practice

The authors highlight that it can be difficult for any one professional to hold a complete picture of a child's progress, but at the same time communication between professionals working in different disciplines can be hampered by a lack of a shared understanding of child development and needs. This needs to be addressed in professional training.

• Early years staff should be equipped with the knowledge and tools needed to recognise slow or atypical development.
• Costs can be a barrier to full implementation of comprehensive preschool programmes. The evidence from Sweden, Cuba and Canada suggests that preschool universal education provision delivers long-term savings that are more than double the costs.
• An early years service that integrates education, health and social care can achieve the maximum benefits of an early years intervention service.

The Children's Society is a national charity that works with the country's most vulnerable children and young people. Research summaries provided by Priya Patel