PREVENTION IS BETTER THAN CURE Background Paper on Preparing for Life

(A)Introduction

Preparing for Life (PFL) is an early intervention/prevention programme jointly funded by the Atlantic Philanthropies (AP) under its Children & Youth Programme and by the Department of Children and Youth Affairs (DCYA) under the PEIP programme (Programme for Early Intervention and Prevention).

PFL is a 5- year intervention programme aimed at testing the efficacy and effectiveness of intervening early in life to prevent the emergence of later difficulties. The aim of the programme is to produce improved outcomes for children and families leading to better school readiness at age 4/5.The programme is a community-based initiative which was developed in a bottom-up approach involving all statutory, voluntary and community groups providing services to children and families in the Dublin 17 area in North Dublin.

We believe that parenting is the most challenging but also the most rewarding task an adult can undertake. We also believe that if parents are supported and have access to accurate information and supports at the appropriate time in relation to their children’s development this will lead to better outcomes for children and families as well as benefits for society and the economy through the cost benefits generated in later life.

The programme has been planned rigorously using evidence of best practice worldwide and a Logic Model approach. A Programme Manual and Programme Materials have been developed.The programme is being evaluated by the UCD Geary Institute using a Randomised Control Trial design, an Implementation Analysis and a Process Evaluation.

PFL is one of 3 programmes established with joint funding from AP and the DCYA. Our partner programmes, Young Ballymun and The Childhood Development Initiative, Tallaght West, are involved in similar early intervention/prevention work. Allied to this there are over 20 further sites across the country rolling out early intervention/preventions initiatives with support from AP.

Important features of these programmes are a commitment to using evidence informed practice as well as rigorous research to determine if these programes are effective.

The Prevention and Early Intervention Network (PEIN) hasbeen established with support from AP and currently has 26 members in the ROI with a parallel network operating in NI.The PEIN has recently launched a website which contains information on all the PEIN programmes and their research.

As evidence and learning about the effectiveness of these programmes is generated and developed it is crucial that this be fed to policy makers and political leaders in a coherent fashion. The Centre for Effective Services (CES) through the Capturing the Learning project are gathering the research learning from across the sites and synthesising it into comprehensive reports.

(B)Background to PFL

Governance:

The Northside Partnership Board is the overall governance agent for PFL.

An external Expert Advisory Committee has been established which provides advice and support in relation to all aspects of programme implementation and research.

Preparing for Life is an Early Intervention/Prevention Programme

PFL was developed based on the recognition that children from disadvantaged community were lagging behind their peers in terms of school readiness skills.

The original participating communitiesof Darndale, Belcamp and Moatview were identified based on a review of Census Data (2002, 2006). The catchment area was extended to include Bonnybrook and Kilmore West.

The PFL community is classified as disadvantaged as approximately 63% of its inhabitants live in social housing (3.5 times the national average), while over 35% of its adults are out of work (compared to the national average of 14.8%). Similarly, only 5% of adults in the community have a third level education, compared to a national average of 25%. In terms of ethnicity, the community is relatively homogenous, with less than 7% of the population being born outside the country (CSO, 2011).”

Baseline research was conducted with families of children that started school in September 2004 to establish evidence for the need for an early intervention/prevention programme.

Among the main findings of this research was thatapproximately 50% of the children were not ready for school when they started and low levels of language and literacy skills, high levels of emotional and behavioural difficulties and parental stress were evident.

In response to this, PFL was developed as a five-year home visiting programme involving the recruitment of a cohort of 200 pregnant women from the community.

Preparing For Life Concept

ThePreparing for LifeProgramme was developed on the basis that children are better prepared for life by having a strong start that enables them to reach their full potential in their early years in their home, community and at school.

Focus of PFL

The focus of PFL is on specific areas that will lead to improved school readiness for children. These include: Child Development, Parenting, Quality Childcareand Interagency Co-Operation. The primary focus of PFL is to improve low levels of school readiness which has been associated with poor peer relationships, psychological well being, and academic achievement, and higher levels of unemployment, teenage pregnancy and criminal activity later in life. PFL operates under a holistic definition of school readiness composed of five dimensions including (1) physical health and well being; (2) socio-emotional development; (3) approaches to learning; (4) language development and emergent literacy and (5) cognitive and general knowledge.

(C)The Programme

What is Different about the PFL Approach?

•Prevention/Intervention programme

•Equipping families to take control of their own lives

•Developing skills in the community

•Engaging agencies in proactive work rather than waiting for a crisis before working with families

•Challenging accepted and unacceptable behaviours

•Creating a model that can be sustained and transferred to other areas

•Supporting quality in early year’s settings.

Expected Outcomes

•Improvements in children's health, personal competencies, education and social relationships

•A range of personal, social and educational problems avoided

•Growing prevention and early intervention expertise

•Increased learning about children’s needs and prevention in areas of social and economic disadvantage

•Improved quality of pre-school provision in the Dublin 17 area

•Effective interagency co-operation and collaboration

•Promoting the benefits of early intervention andprevention for families

•Influencing policy and gaining public and politicalsupport for the model of early intervention and prevention.

What are we testing?

Our hypothesis is that if parents are adequately supported during pregnancy and the early years of a child’s life this will lead to improved outcomes for children, their families, schools and wider society. Waiting until children arrive in school before intervening leads to a range of negative outcomes for children and their families which begin to manifest themselves as soon as the child arrives in school. Many of these negative outcomes continue to be a drain on resources throughout the child’s life.

PFL is offering intensive supports to parents through:

Mentoring:

(1)Mentoring – This involves one to one work with families either in their own home or a centre based setting. A full curriculum has been developed and a team of 5 mentors work through this with all families at planned sessions. The mentors come from a variety of backgrounds including teaching, psychology, youth work and social work. Prior to commencing work mentors went through rigorous training in the PFL manual and they are supervised on an ongoing basis.

(2)The aim of the planned home/centre based- visits is to support and help parents with key parenting issues using a set of PFL developed tip-sheets. The mentoring involves (i) building a good relationship with parents, (ii) providing them with high quality information, (iii) being responsive to issues that arise; and in these ways (iv) enable parents to make informed choices (where possible encouraging and supporting good practice) and (v) signpost them to other relevant services. The mentors focus on five general areas (1) nutrition, (2) rest and routine, (3) safety and supervision, (4) cognitive, emotional and social development, and (5) parents and their supports.

Parenting Training:

Triple P which is a Multi –level system of family intervention for parents of children whohave, or at risk of, developing behaviour problems. The aim of Triple P is to increase parental competence and confidence in raising children.

Triple P evolved from clinical research which began in Australia 1993 and has been rigorously evaluated showing proven effects.

  • The PFL mentors are accredited in three Triple P programmes:

Primary - narrow focus parenting skills training

Group – broad focus parenting skills training

Seminars – focus on specific parenting issues

Quality Early Years Services:

We also work with 10 local early year’s providers in implementing the National Quality Framework for Early Years Education and Care (Síolta).

  • PFLhas supported the rollout of the Síolta Framework in 10 early year’s settings serving the PFL catchment area. Our preschools/crèches were the first in the country to engage with the Síolta framework. To date 6 settings have submitted portfolios to the DCYA and 5 have been independently accredited (oneis awaiting an accreditation visit).

(D) Research

The Geary Institute, based at University College Dublin, are evaluating the effectiveness of the Preparing for Life (PFL) Programme at improving outcomes for children and families, in addition to evaluating the cost effectiveness of the programme. The research team is led by Dr. Orla Doyle and includes 4 researchers. The team is advised locally by Professor Colm Harmon and Professor Cecily Kelleher,and internationally by a team of world leading scientists in economics (Nobel Laureate Professor James Heckman, University of Chicago & UCD) and developmental psychology (Professor Richard Tremblay, University of Montreal & UCD and Professor SharonRamey, Georgetown University). The evaluation is an integral part of PFL and has been designed to ensure an evaluative structure that maximises the probability of clear, definitive and meaningful outcomes that reflect local contexts while reflecting adherence to the underlying programme design and the logic model. The information below sets out the context for the evaluation and outlines the activities which will ensure that the evaluation will produce definitive and rigorous evidence on whether such preventative programme are effective in an Irish context.

Effectiveness of early prevention programmes

The intergenerational transmission of socioeconomic inequalities emerges early and can persist through life[1]. Many subsequent social issues, such as crime, unemployment, teenage pregnancy, and low education, as well as mental health disorders, can be traced back to an adverse early environment[2]. Remediation policies are the most common method for addressing social inequalities, yet they are both costly and less effective than preventative policies. Evidence suggests that targeted, early intervention programmes aimed at disadvantaged children and their families are an effective means of reducing these inequalities.

Is early intervention in Ireland more cost effective than later remediation?

Early intervention is also economically efficient. Research on US programmes has shown high rates of return to government investment such that the personal benefits (cognitive development, behaviour and social competence, educational attainment, earnings), social benefits (reduced delinquency and crime) and government savings (higher tax revenues, reduced social welfare spending), associated with intervening early in a child’s life clearly outweigh the costs[3]. For example, the US Perry Preschool Programme resulted in higher levels of education, employment, and earning, and lower rates of crime, teenage pregnancy and social welfare dependency, resulting in an estimated social rate of return of between 7-10% per annum[4]. Nobel Laureate James Heckman, pioneer of the economic context of early intervention and a co-investigator on the Preparing for Life programme, finds that the process by which early skill formation facilitates the accumulation of more advanced skills later in life is the key. By investing early, the benefits are enjoyed for longer, which in turn increases the return to investment.[5]

Thus, intervening early in life to improve the skills and capabilities of at risk children, and thus reduce their later burden on society, is becoming an increasingly popular public policy argument. Yet this evidence is almost exclusively US-based and there is a clear lack of research on the long term effects of early intervention in Ireland. The evaluation of PFL will be among the first to provide evidence on the effectiveness of early childhood interventions in Ireland.

Evaluation of Preparing for Life Programme

PFL is being evaluated using an experimental longitudinal design and an implementation analysis. The experimental component involves the random allocation of participants to either a low supports treatment group (BLUE) or a highsupports treatment group (GREEN). Randomised controlled trials are the gold standard methodology for evaluating the effectiveness of policies or interventions as any differences in the outcomes of the two groups may be causally linked to the programme, thus proving whether the programme is effective or not. The PFL treatment groups also are being compared to a ‘services as usual’ comparison group, who do not receive the PFL programme.

PFL Experimental Evaluation

The experimental evaluation collects data on children’s physical health and motor skills, social and emotional development, and behaviour, learning, literacy and language development, and the mother’s pregnancy behaviours, physical and psychological health, cognitive ability, personality, and parenting skills from pregnancy onwards.

  • 233 participants have been randomised with 115 in the high treatment group and 118 in the low treatment group. 95 participants in the comparison community have been recruited.
  • Data are collected from all three groups at pre-intervention (t0), 6 months (t1), 12 months (t2), 18 months (t3), 24 months (t4), 3 years (t5), 4 years (t6) and 5 years (t7).
  • The mother is the primary informant; however information is also obtained from fathers, the child, siblings, and other independent data sources, such as hospital records.
  • Currently, the 6 month, 12 month and 18 month data collections are complete and 24 month, 36 month and 48 month surveys are being conducted in the field.
  • Interim Reports for 6 and 12 month results have been completed.

PFL Implementation Evaluation

In order to fully interpret and understand the effects of PFL, we are also conducting an implementation analysisof the programme as varying levels of implementation equate to varying levels of treatment and ultimately varying levels of effectiveness at improving outcomes for vulnerable children and families.The implementation evaluation is being conducted using a multi-sequenced design including:

  • implementation data recorded by programme staff (using a web-based Database Management System) are also being tracked on an ongoing basis to measure programme participation and service provision
  • focus group with participants to track programme satisfaction and subjective effectiveness(three sessions throughout the course of programme),
  • semi-structured interviews with programme staff to assess programme implementation and fidelity.

Results:

To date the 6, 12 and 18 month data wave collections are complete and results from the analysis of these three data sets is available. As final reports are written up the reports become available on the following websites: and

Cost benefit analysis

A cost benefit analysis of PFL is also being conducted to determine the long term cost effectiveness of the programme. Building a long-term model for assessing the cost effectiveness of PFL can be thought of in 4 stages, 1) assessing the direct impacts and costs of PFL, 2) quantifying the knock-on effects of improved school readiness, 3) assessing impacts on lifetime earnings and employment and 4) estimating the long-term costs and benefits. This 4 stage approach uses a variety of primary and secondary data sources and allows for the accurate assessment of economic costs and benefits to the individual and society in general. Professor James Heckman and his team are advising the Geary Institute on the cost benefit analysis of PFL.

For further information please contact Noel Kelly, Preparing for Life manager at -01-8771509, or by email at

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[1] Najman, J.M., Aird, R, Bor, W., O’Callaghan, M., Willians, G.M, Shuttlewood, G.J. (2004). The generational transmission of socioeconomic inequalities in child cognitive development and emotional health. Social Science and Medicine, 58, 1147–1158.

[2] Brooks-Gunn, J. (2003). Do you believe in magic? Social Policy Report, 17(1), 3-16.

[3] Karoly, L. A., Kilburn, M. R. & Cannon, J. S. (2005). Early childhood interventions: Proven results, future promise. Santa Monica, CA: RAND Corporation.

[4] Heckman, J.J., Moon, S.H., Pinto, R., Savelyev, P.A., & Yavitz, A.Q. (2010). The rate of return to the HighScope Perry Preschool Program. Journal of Public Economics, 94(1-2), 114-128.

[5] Heckman, J., Cunha, F., Lochner, L. Masterov, D. (2006). Interpreting the Evidence on Life Cycle Skill Formation. In: E. Hanushek & F. Welch (Eds.), Handbook of the Economics of Education. Amsterdam: North-Holland.