Support from the Start: working with children and their families to reduce the risks of crime and antisocial behaviour

Support from the Start: working with children and their families to reduce the risks of crime and antisocial behaviour

Article Type: Guest editorial From: Journal of Children’s Services, Volume 7, Issue 1

Service planners, practitioners and researchers in the thick of developments in social policy sometimes find it difficult to draw breath for long enough to take stock of whether genuine progress is being made. This special issue of the Journal of Children’s Services seeks to do that regarding work with children and their families to reduce the risks of crime and antisocial behaviour. Its point of reference is a report called Support from the Startthat resulted from a series of seminars at the Royal Society in London and was published by the (then) Department of Education and Skills (Sutton et al.,2004). This argued strongly, from a detailed examination of the evidence, that the life chances of children and young people at risk of drifting into careers of chronic and violent offending could be transformed if interventions known to be effective were more widely available in Britain. Researchers, it suggested,should be doing more to illuminate the choices facing policy makers and communities by supplying them with accessible information about the cost-effectiveness of services and the ingredients needed to implement them successfully. But it insisted that this should not be used as an excuse to delay further action.

Many of the original contributors – augmented by other experts –have been brought together for this collection of papers to consider what has changed in the intervening period. Eight years may not seem long, but, as the authors demonstrate, it has seen important advances in the underpinning science of prevention as well as expanding knowledge regarding early intervention programmes and their effectiveness. Nor have policy and practice stood still;greater political recognition in now given to the case for prevention, and there is more practical insistence on judging services according to the actual outcomes achieved for children and young people. It would be stretching a point to say that a fully fledged “evaluation culture” has emerged, but the UK trials have been instigated of a number of rigorously researched interventions from overseas, notably the Nurse-Family Partnership (Olds et al., 1998), Functional Family Therapy (Alexander et al.,1998), Incredible Years (Webster-Stratton et al., 2003), Multidimensional Treatment Foster Care (Chamberlain and Mihalic, 1998), Multisystemic Therapy (Henggeler et al., 1998), PATHS (Greenberg and Kusché, 2002) and Triple P (Sanders et al., 2003). Knowing more, we inevitably discover there is more to learn, but the pace of change has, in many ways, been impressive.

Genetics and neuroscience

While acknowledging that there is no “gene for crime” (Rutter et al., 2006), Support from the Start described emerging evidence concerning the indirect influence of children’s genetic inheritance on behaviour through temperament and factors such as hyperactivity or impulsivity. It also referred to ways that genes and a child's environment may interact,contributing either to vulnerability or resilience. Reflecting the emphasis that our current contributors have been asked to place on advances in practical prevention, these issues are not discussed in depth. However, we note that reviewers of research in recent years have become more emphatic concerning gene-environment interactions and that there is growing acceptance that genes exert their influence through temperament which, in turn, influences behaviour(Rutter, 2010). Research has also become more discerning about the ways in which these interactions can occur; for example regarding the relationship between a small number of children who exhibit (highly heritable) callous-unemotional traits, their hormone levels and parental upbringing (Hawes et al.,2009).

Studies of the way the human brain matures have, meanwhile, provided tantalising neuroscientific support for long-standing observations of the link between impulsiveness and failure to anticipate consequences during adolescence and antisocial behaviour. “Neural pruning” as been shown to take place during adolescence is part of a change process that, while it occus,reduces the brain’s capacity to control impulses and contributes to mood swings (Asmussen et al., 2007; Fagan and Eisenberg, 2012). While a direct link between children’s normal development and criminal behaviour is unlikely (Rutter, 2010), the emerging evidence concerning children’s neuropsychological vulnerabilities holds implications ranging from the way we parent adolescents to policy decisions about the minimum age of criminal responsibility (set in England and Wales at the internationally low age of ten)(Farmer, 2011).

Risk, protective and promotive factors

Support from the Start made its case for preventive services based on a “public health” model of prevention. This argues that action at a population level to reduce known risk factors for crime and antisocial behaviour in children’s lives and to enhance protective factors will reduce both criminality and crime. From a policy perspective, an advantage of this paradigm, relying on statistical predictors identified through prospective longitudinal research, is that its viability does not depend on complete knowledge concerning causation. Eight years ago, as now, there was a lack of clarity about the salience of individual risk factors and the sequences and combinations in which they influence children’s lives. Nevertheless, there has been progress in refining the model, including moves towards greater consistency in the definition and understanding of “protection”. There is now greater acceptance that protective factors, instead of being used to describe the opposite of risk (“good”, rather than “poor”parental supervision, for example), can most usefully be defined as interactive factors that attenuate children’s exposure to risk and enable positive outcomes in otherwise difficult circumstances. Moreover, recent evidence emerging from the longitudinal Pittsburgh Youth Study in the USA and a re-analysis of data from the Cambridge Study in Delinquent Developmentin the UK suggest that variables predicting a low probability of later offending– termed “a promotive” factor – are not always the exact opposite of risk factors. In some cases, a factor may be strongly related to a low likelihood of criminal behaviour, while there is no linear relationship between its absence from children’s lives and increased risk of criminal behaviour (Loeber et al., 2008; Farrington and Ttofi, 2011). While requiring replication, these findings are an example of the way that a model,though already serviceable, has the potential to be refined and, where necessary, re-defined to improve its practical application.

Another policy-relevant concept highlighted eight years ago was the distinction made by Moffitt (1993) between the pathways followed by young people who engage in criminal behaviour for a relatively short time (“adolescence-limited”)and those whose persistent antisocial behaviour from an early age develops into a “life-course persistent” offending career. Modifications to this separation now include evidence of the way that “adolescence-limited”offending can extend into young adulthood and a recognition that many children whose behaviour is abnormally antisocial for their age do not develop into persistently antisocial adults (Odgers et al., 2007). Rutter (2010) has further argued that the links between a strong family history of antisocial behaviour and life-course persistent offending suggest the possible importance of genetic liability. These are valuable new insights that qualify, but do not challenge, a central contention in Support from the Start that preventive intervention with severely antisocial children will prove disproportionately useful in preventing chronic and serious offending.

Interventions, implementation and cost-effectiveness

The description of well-evidenced preventive programmes in this special issue is selective and focused mainly on availability in the UK. It is spread between six papers, four of which relate to developmental stages between pregnancy and adolescence. Reflecting reality, the boundaries between them are necessarily blurred, and a number of high-quality interventions are referenced in more than one paper[1]. In terms of progress, we see how continuing research into the effectiveness of these and other programmes has supported their introduction,evaluation and spread in the UK. Thus, the Nurse-Family Partnership (known in England as the Family Nurse Partnership) is described in papers on pregnancy by Glover and Sutton and on young children by Sutton et al. and is now provided in 50 English sites and subject to a randomised controlled trial in 18 of them. Advancing knowledge has also helped the originators of programmes to adapt their approaches for use with other age groups and in different settings. Variants of the Incredible Years and Triple P parenting programmes are discussed by Hutchings and Gardner in their paper on three to eight-year olds and by Bywater and Utting in the context of nine to 13-year olds.

Other advances described include the introduction to the UK of additional interventions that have demonstrated their effectiveness in overseas evaluations. Those from USA include the Success for All programme(Borman et al., 2007), promoting literacy and numeracy among primary school children, and the Life Skills Training curriculum (Botvin et al., 1998, 2006) for improving children and young people’s cognitive and social skills, while the KiVa programme from Finland is designed to prevent school bullying (Salmivalli et al., 2011). Families and Schools Together (FAST) (McDonald et al., 1997), meanwhile,provides the unusual example of a multimodal preventive approach that originated in the UK, but whose strongest supporting evidence to date has come from American research.

While the USA remains the major source of high-quality evaluations in this field, it is significant that Fagan and Eisenberg, in a paper on developments in America, focus on progress towards disseminating and applying an expanding knowledge base, rather than on specific interventions. While reporting progress in recognising key ingredients of effective programmes and achieving faithful replication, their overview also describes a renewal of interest in “operating systems” for planning and implementing preventive services at local level. These include the development of Evidence2Success; an approach that builds in part on the Communities that Care prevention system that is,itself, supported by stronger evaluative evidence than existed eight years ago.

As Fagan and Eisenberg observe, another strategy increasingly used to assist the spread of evidence-based interventions is the publication of information about their financial costs and benefits. The Washington State Institute of Public Policy has played a leading role in developing this work, so we anticipate considerable interest in the paper by three of its leading researchers and colleagues who are working to apply its methods in the UK (Lee et al., 2012). This uses an assessment of the cost-benefits of early education programmes as a case study to describe the methods used and their implications for policy.

Challenges ahead

It is worth remembering that hardly any evidence-based programme has been taken to scale, even in the USA. Even if they were, such interventions are not a panacea. Yet it is undeniable that we live in stimulating times for the advancement and application of prevention science. This special issue celebrates the fact with an afterword by Graham Allen MP, whose reports to government on early intervention (Allen, 2011a, b) are now the principal driver of the UK policy in this area. His initiative to create an Early Intervention Foundation to develop and disseminate the evidence base for prevention and early intervention and to monitor independently the effectiveness of programmes is in obvious accord with the messages from our other contributors. Success in establishing such an institution will, nevertheless, bring fresh challenges. At a policy level, the continuing economic crisis and public spending squeeze serves to stimulate interest in cost-effective services while, ironically,choking-off normal channels for the initial investment needed to deliver long-term savings. There is also growing awareness of a need to pay more attention to making programmes “system ready” and systems “programme ready” if interventions like the ones described in this edition are to become integral to systems or “scaled-up” (Little, 2010). In relation to research, there is a continuing agenda to refine knowledge concerning risk,protection and causation, as well as a drive to apply robust assessment methods to a wider range of interventions. Here, too, cost is an ever-present issue,making it likely that, despite the discernible recent shift towards more rigorous, controlled evaluations, pragmatic compromises will continue to be made. If so, one plea must be for more consistent terminology, so that strategists and practitioners can be clearer about the strength of any evidence presented to them. As the range of research expands concerning effective services, the more important it becomes that terms like “promising”,“what works” – and “effective” itself – are attached less loosely and only to the interventions that genuinely merit them. Clear standards of evidence, applied consistently, will make a significant contribution here, and should be extended in future beyond programmes, to encompass policies, practices and processes. The case for equipping children and families with “support from the start” has never been stronger; but its continued persuasiveness depends on raising the quality as well as quantity of support that is provided.

David Utting

Note

1. To avoid undue repetition the editors have avoided including substantive descriptions of individual interventions in more than one paper.