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On Estimating the Fiscal Benefits of Early Intervention

Published online by Cambridge University Press:  01 January 2020

Leon Feinstein*
Affiliation:
Office of the Children's Commissioner
Haroon Chowdry*
Affiliation:
Office of the Children's Commissioner
Kirsten Asmussen
Affiliation:
Early Intervention Foundation

Abstract

In this paper we explain some of the difficulties of providing forecasts of the financial benefits of early intervention programmes, focussing on those delivered during the early childhood period. We highlight the diversity of early intervention, and the complexity and multiplicity of outcomes. We summarise recent work at the Early Intervention Foundation to assess the evidence on the impacts of early intervention, recognising the diversity of approaches to delivery and the importance of innovation and local practice as well as of rigorous approaches to evaluating causal effects. We also describe new ways of assessing accurately the local fiscal costs of late intervention and consider the implications of this for addressing the well-established barriers to investment in prevention. Our analysis brings to the fore gaps in the evidence from which even the most rigorous ‘gold-standard’ research is not immune. These limitations prevent the production of an accurate and realistic cost-benefit ratio or net present value for the majority of programmes as delivered in practice. We suggest some paths towards a firmer foundation of evidence and a better alignment of evidence and policy.

Type
Research Articles
Copyright
Copyright © 2017 National Institute of Economic and Social Research

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Footnotes

We are grateful to funders, trustees and birth parents of the Early Intervention Foundation for establishing the Centre and steering the research agenda and to Carey Oppenheim, Jack Martin, Daniel Acquah and Donna Molloy for multiple comments and discussions about the work. We owe a particular debt to the many programme developers, practitioners and academics whose work we have reviewed and whose insights have taken the field forward and to the children and families who have participated in the research. We are grateful to Peter Fitzsimons, Lara Doubell, Georgia Vourloumi and Ilenia Piergallini for valuable research assistance. All errors and oversights remain our own.

References

Action for Children (2013), The Red Book 2013: Children under Pressure.Google Scholar
Allen, G. (2011), Early Intervention: The Next Steps, An Independent Report to Her Majesty's Government by Graham Allen MP, The Stationery Office.Google Scholar
Almond, D. and Currie, J. (2011), ‘Human capital before age five’, in Ashenfelter, O. and Card, D. (eds), The Handbook of Labor Economics, Vol. 4, Chapter 15, Amsterdam: Elsevier, pp. 1315–486.Google Scholar
Almond, D., Currie, J. and Duque, V. (2017), ‘Childhood circumstances and adult outcomes: act II’, NBER Working Paper 23017.CrossRefGoogle Scholar
Asmussen, K., Feinstein, L., Martin, J. and Chowdry, H. (2016), Foundations for Life: What Works to Support Parent Child Interaction in the Early Years, London: Early Intervention Foundation.Google Scholar
Barnes, J., Ball, M., Meadows, P., Belsky, J. (2009), Nurse-Family Partnership Programme. Second Year Pilot Sites Implementation in England. The Infancy Period, Research Report DCSF-RR166.Google Scholar
Bonell, C., Fletcher, A., Morton, M., Lorenc, T. and Moore, L. (2012), ‘Realist randomised controlled trials: a new approach to evaluating complex public health interventions’, Social Science and Medicine, 75 (12), pp. 2299–306.CrossRefGoogle ScholarPubMed
Bonin, E.M., Stevens, M., Beecham, J., Byford, S. and Parsonage, M. (2011), ‘Parenting interventions for the prevention of persistent conduct disorders’, in Knapp, M.J., McDaid, D. and Parsonage, M. (eds), Mental Health Promotion and Mental Illness Prevention: The Economic Case, 68, London: Department of Health.Google Scholar
Bono, E.D., Francesconi, M., Kelly, Y. and Sacker, A. (2016), ‘Early maternal time investment and early child outcomes’, Economic Journal, 126, F96F135.CrossRefGoogle Scholar
Brooks-Gunn, J. (2003), ‘Do you believe in magic? What we can expect from early childhood intervention programs’, Social Policy Report, 17 (10), pp. 314.CrossRefGoogle Scholar
Campbell, F.A., Pungello, E.P., Burchinal, M., Kainz, K., Pan, Y., Wasik, B.H., Barbarin, O.A., Sparling, J.J. and Ramey, C.T. (2012), ‘Adult outcomes as a function of an early childhood educational program: an Abecedarian Project follow-up’, Developmental Psychology, 48 (4), pp. 1033–43.CrossRefGoogle ScholarPubMed
Cartwright, N. (2011), ‘A philosopher's view of the long road from RCTs to effectiveness’, The Lancet, 377 (9775), pp. 1400–1.CrossRefGoogle Scholar
Charles, J. M., Edwards, R.T., Bywater, T. and Hutchings, J. (2013), ‘Micro-costing in public health economics: steps towards a standardized framework, using the Incredible Years Toddler Parenting Program as a worked example’, Prevention Science, 14 (4), pp. 377–89.CrossRefGoogle ScholarPubMed
Chowdry, H. and Fitzsimons, P. (2016a), The Cost of Late Intervention: EIF analysis 2016, London: Early Intervention Foundation.Google Scholar
Chowdry, H. and Fitzsimons, P. (2016b), The Cost of Late Intervention: EIF analysis 2016 – Technical Report, London: Early Intervention Foundation.Google Scholar
Cicchetti, D. and Rogosch, F. (1996), ‘Equifinality and multifinality in developmental psychopathology’, Development and Psychopathology, 8 (4), pp. 597600.CrossRefGoogle Scholar
Cunha, F. and Heckman, J.J. (2008), ‘Formulating, identifying and estimating the technology of cognitive and noncognitive skill formation’, Journal of Human Resources, Fall, 43 (4), pp. 738–82.CrossRefGoogle Scholar
Cunha, F., Heckman, J.J. and Schennach, S.M. (2010), ‘Estimating the technology of cognitive and noncognitive skill formation’, Econometrica, 78, pp. 883931.Google ScholarPubMed
Dearden, L., Sibieta, L. and Sylva, K. (2011), ‘The socio-economic gradient in early child outcomes: evidence from the Millennium Cohort Study’, Longitudinal and Life Course Studies, 2 (1), pp. 1940.Google Scholar
Department of Health (2013), Chief Medical Officer's Annual Report 2012: Our Children Deserve Better: Prevention Pays, 24 October.Google Scholar
Durlak, J.A. and Wells, A.M. (1998), ‘Evaluation of indicated preventive intervention (secondary prevention) mental health programs for children and adolescents’, American Journal of Community Psychology, 26, pp. 775802.CrossRefGoogle ScholarPubMed
Eckenrode, J., Campa, M., Luckey, D., Henderson, C., Cole, R., Kitzman, H., Anson, E., Sidora-Arcoleo, K., Powers, J. and Olds, D. (2010), ‘Long-term effects of prenatal and infancy nurse home visitation on the life course of youths: 19-year follow-up of a randomized trial’, Archives of Pediatric and Adolescent Medicine, 164, pp. 915.CrossRefGoogle ScholarPubMed
Fixsen, D., Blase, K., Naoom, S., Wallace, F. (2009), ‘Core implementation components’, Research on Social Work Practice, 19, pp. 531.CrossRefGoogle Scholar
Flay, B.R., Biglan, A., Boruch, R.F., Castro, F.G., Gottfredson, D., Kellam, S., Moscicki, E.K., Schinke, S., Valentine, J.C. and Ji, P. (2005), ‘Standards of evidence: criteria for efficacy, effectiveness and dissemination’, Prevention Science, 6 (3), pp. 151–75.CrossRefGoogle ScholarPubMed
Friedli, L. and Parsonage, M. (2007), Mental Health Promotion: Building an Economic Case, Northern Ireland Association for Mental Health.Google Scholar
Goodman, A., Joshi, H., Nasim, B. and Tyler, C. (2015), Social and Emotional Skills in Childhood and their Long-Term Effects on Adult Life, London: Early Intervention Foundation.Google Scholar
Goodman, A., Joyce, R. and Smith, J.P. (2011), ‘The long shadow cast by childhood physical and mental problems on adult life’, Proceedings of the National Academy of Sciences of the United States of America, 108 (15), pp. 6032–7.CrossRefGoogle Scholar
Heckman, J.J. (2008), ‘Schools, skills and synapses’, Economic Inquiry, 46 (3), pp. 289324.CrossRefGoogle ScholarPubMed
Heckman, J.J., Moon, S.H., Pinto, R., Savelyev, P.A. and Yavitz, A. (2010), ‘The rate of return to the HighScope Perry Preschool Program’, Journal of Public Economics, 94 (1), pp. 114–28.CrossRefGoogle Scholar
Hiscock, H., Bayer, J.K., Price, A., Ukoumunne, O.C., Rogers, S. and Wake, M. (2008), ‘Universal parenting programme to prevent early childhood behavioural problems: cluster randomised trial’, BMJ: British Medical Journal, 336 (7639), pp. 318–21.CrossRefGoogle ScholarPubMed
HM Treasury (2011), The Green Book: Appraisal and Evaluation in Central Government, London: The Stationery Office.Google Scholar
Kalinauskiene, L., Cekuoliene, D., VanIJzendoorn, M.H., Bakermans-Kranenburg, M.J., Juffer, F., and Kusakovskaja, I. (2009), ‘Supporting insensitive mothers: the Vilnius randomized control trial of video-feedback intervention to promote maternal sensitivity and infant attachment security’, Child: Care, Health and Development, 35, pp. 613–23.Google ScholarPubMed
Kitzman, H., Olds, D.L., Henderson, C.R., Hanks, C., Cole, R., Tatelbaum, R., McConnochie, K.M., Sidora, K., Luckey, D.W., Shaver, D., Englehardt, K., James, D. and Barnard, K. (1997), ‘Effect of prenatal and infancy home visitation by nurses on pregnancy outcomes, childhood injuries, and repeated childbearing’, Journal of the American Medical Association, 278 (8), pp. 644–52.Google ScholarPubMed
Marchal, B., Westhorp, G., Wong, G., Van Belle, S., Greenhalgh, T., Kegels, G. and Pawson, R. (2013), ‘Realist RCTs of complex interventions – an oxymoron’, Social Science and Medicine, 94, pp. 124–8.CrossRefGoogle ScholarPubMed
National Audit Office (2013), Early Action: Landscape Review, London: The Stationery Office.Google Scholar
NICE (2013), Antisocial Behaviour and Conduct Disorders in Children and Young People – Costing Report: Implementing NICE Guidance, National Institute for Health and Clinical Excellence.Google Scholar
Pawson, R. (2013), The Science of Evaluation: A Realist Manifesto, London: Sage.CrossRefGoogle Scholar
Phillips, D.A. and Shonkoff, J.P. (eds). (2000), From Neurons to Neighborhoods: The Science of Early Childhood Development, National Academies Press.Google Scholar
Piaget, J. (2013), The Construction of Reality in the Child (Vol. 82), Abingdon: Routledge.CrossRefGoogle Scholar
Robling, M., Bekkers, M., Bell, K., Butler, C., Cannings-John, R., Channon, S., Martin, B., Gregory, J., Hood, K., Kemp, A., Kenkre, J., Montgomery, A., Moody, G., Owen-Jones, E., Pickett, K., Richardson, G., Roberts, Z., Ronaldson, S., Sanders, S., Stamuli, E. and Torgerson, D. (2016), ‘Effectiveness of a nurse-led intensive home-visitation programme for first-time teenage mothers (Building Blocks): a pragmatic randomised controlled trial’, The Lancet, 387 (10014), pp. 146–55.CrossRefGoogle ScholarPubMed
Rush, J. (2009), ‘The role of efficacy and effectiveness trials’, World Psychiatry, February, 8 (1), pp. 34–5.CrossRefGoogle ScholarPubMed
Sainsbury Centre for Mental Health (2009), The Chance of a Lifetime: Preventing Early Conduct Problems and Reducing Crime, London: Sainsbury Centre for Mental Health.Google Scholar
Scott, S., Knapp, M., Henderson, J. and Maughan, B. (2001), ‘Financial cost of social exclusion: follow up study of antisocial children into adulthood’, British Medical Journal, 323, pp. 15.CrossRefGoogle ScholarPubMed
Sherman, L.W., Gottfredson, D.C., MacKenzie, D.L., Eck, J., Reuter, P. and Bushway, S.D. (1998), National Institute of Justice: Research in Brief, July 1998, U.S. Department of Justice.Google Scholar
Shonkoff, J.P., Boyce, W.T. and McEwen, B.S. (2009), ‘Neuroscience, molecular biology, and the childhood roots of health disparities: building a new framework for health promotion and disease prevention’, JAMA, 301 (21), pp. 2252–9.CrossRefGoogle ScholarPubMed
Shonkoff, J.P., Garner, A.S., Siegel, B.S., Dobbins, M.I., Earls, M.F., McGuinn, L. and Committee on Early Childhood, Adoption, and Dependent Care (2012), ‘The lifelong effects of early childhood adversity and toxic stress’, Pediatrics, 129 (1), e232e246.CrossRefGoogle ScholarPubMed
Smith, J.P., Monica, S. and Smith, G.C. (2010), ‘Long-term economic costs of psychological problems during childhood’, Social Science and Medicine (1982), 71(1), pp. 110–15.CrossRefGoogle ScholarPubMed
The Prince's Trust (2010), The Cost of Exclusion: Counting the Cost of Youth Disadvantage in the UK, London: The Prince's Trust.Google Scholar
Utting, D. (2007), Parenting and the Different Ways it Can Affect Children's Lives: Research Evidence, York: Joseph Rowntree Foundation.Google Scholar