Re-Imagining Prevention and Early Intervention

Prevention and early intervention are now a well-established enterprise in children’s services in the UK and numerous other western developed countries, demonstrated, for example, by the proliferation of standards of evidence, evidence-based programs (EBPs) and online databases of EBPs. However, the field has recently come under sustained attack, partly from critics who object fundamentally (mainly on ideological and scientific grounds) but also from those who are essentially supportive but think it could do much better. Meanwhile, trends in science, policy and wider society are either resulting in changes in the field already or should prompt a rethink. Examples include a greater emphasis on individual preferences, a deeper appreciation of complexity and the rapid expansion of digital technology.

This paper describes current shifts in prevention and early intervention, exploring their origins and the opportunities and challenges they present. The shifts fall broadly into two categories, albeit with links between them: (1) how we intervene (the nature of intervention); and (2) how we test (the evaluation of early intervention).

The first category includes: from designing interventions in the laboratory to co-producing them with stakeholders in context; from discrete interventions to whole system approaches; from fidelity to design to personalisation and dynamic adaptation in context; from manualised programs to effective components; from contained ('nuclear') logic models to expansive ('extended' logic models; and from contact time, real and 'clinic' to 24/7, virtual and home.

The second category includes: from ‘what works’ to what works for whom, when, where, why and at what cost; from more research to smarter research; from chasing external endorsement to internal learning and improving' and and from slow linear testing to rapid cycle testing.

We argue that, collectively, these changes are moving the early intervention field in four directions: a broadening (in focus and reach); a relaxing (more flexible and dynamic, less prescribed and static); a deepening (more nuanced and sophisticated); and a scrambling (more iterative, less linear). While these developments are positive insofar as they represent concrete responses to observed problems, they also present challenges. For instance, new approaches to designing and testing interventions are in their infancy, meaning that time is needed to develop the necessary expertise and skills, and in some areas there is a danger of executing U-turns when what is needed is a recalibration.