Centre for Mental Health

Our early years programme

Behavioural or conduct problems which emerge early in childhood are very likely to persist into later life. They are associated with a wide range of adverse outcomes, including not only continuing mental health difficulties but also poor educational and labour market performance, poor health, disrupted personal relationships, criminality, substance misuse and reduced life expectancy. Particularly for the one in 20 young children whose problems are sufficiently severe to merit a clinical diagnosis of conduct disorder, life chances are seriously compromised.

Early intervention

Yet early onset conduct problems have identifiable and, in many cases, preventable risk factors. Much is now known about how to mitigate these problems. An increasingly strong body of evidence demonstrates the effectiveness of a range of family- and school-based programmes to intervene early and to prevent problems occurring at all or to prevent existing problems from lasting or escalating.

Despite the undoubted benefits, both for individuals and for society as a whole, the availability of these programmes falls well short of what is needed and the quality of services is very variable.

A range of barriers hinder the provision of evidence-based interventions. For example, programmes are not always compliant with what we know works. Many fail to target those who need them most. Take-up rates are low and drop-out rates are high. In short, there is a sizeable gap between the promise of research and the reality of current practice in the effort to transform the life chances of thousands of children with early conduct problems.

Improving the life chances of vulnerable children

With funding from the Esmée Fairbairn Foundation, our aim is to bridge this gap through a two-year programme of research and development, which began in April 2011. Our research will analyse the key constraints on the delivery of effective interventions. We will collaborate with families, practitioners, providers and commissioners to work up practical means of improvement.

The key focus throughout will be on how to improve the implementation and delivery of evidence-based programmes.

Phase one - review of evidence and current practice

During the first phase of this work, we will make contact with a range of experts and key players in and around the field of early years mental health to inform them about the project and find out what other work is taking place that may be relevant. In the early stages of the project, we will establish an expert advisory group to help inform developments and planning and to help shape next steps at each stage.

We will collect detailed information from a number of sources, including through literature searches and reviews, exploring what is known about the effective implementation of evidence based programmes. These reviews will focus on a number of key areas:

1. How do we ensure that programmes are most effectively implemented and targeted at those who are most likely to benefit?
2. How do we then maximise the engagement of those families most likely to benefit from these interventions and reduce the chances of them dropping out of these support programmes?
3. How do we ensure that programmes minimise the chances of stigmatising the children and families these programmes are seeking to empower and assist?
4. From a health economic perspective, how can we ensure that resources are allocated most efficiently? So for example, if a fixed budget is available for commissioners, what interventions should be provided at what ages in order to maximise overall returns?

Alongside these reviews, we will collect detailed information on what is happening in practice at the frontline. We will talk to families, practitioners, schools, commissioners and other key stakeholders to explore challenges and solutions in the effective implementation of evidence based interventions designed to improve the life chances of vulnerable children. In selected local areas, we will carry out in-depth studies of the practice 'landscape' and a broader survey of practice developments will build up a picture of the service landscape in the wake of the Graham Allen’s review.

Phase two - publishing the results

Dependent upon and shaped by the findings of phase one, the Centre will produce a range of outputs to support stakeholders (individual practitioners, commissioners, providers and policy makers). These are likely to be in the form of practical support materials such as guidance, toolkits, quality standards, outcome measures etc.

At the conclusion of each phase of work, we will publish key findings and will organise high-profile consultation events, to help disseminate knowledge and shape the next steps of this important developmental programme of work. Findings will also feed into the Government’s evolving Foundation Years agenda.