PHT June 2011_Jan 10 - UK Faculty of Public Health

SPECIAL FEATURE: EARLY INTERVENTION
Let’s not forget
interventions in
later years
WE SHOULD resist being swept along by
the political and professional tide of ‘early
years’ interventions as this may divert
much needed resources from vulnerable
teenagers.
Serious problems may arise in the lives of
children at any age, not just during the
early years. Research on the maltreatment
of teenagers reveals that just over 9,000
young people, aged 10-17, are the subject
of a child protection plan – a greater
number than those aged under one, and a
similar number to those aged five to nine.
And there are higher rates of neglected
young people (aged 10-16 and over)
subject to a child protection plan than
those physically, sexually and emotionally
abused in the younger age bands (aged
one to four, five to nine).
Behind these statistics lie a catalogue of
problems, many arising for the first time
during teenage years: the 14-year-old
young man, rejected and abused by his
mum’s new partner, who ran away from
home and ended up on the streets,
desperate and having to beg and steal to
survive; the 13-year-old girl, spending most
of her time looking after her recently
disabled mum, missing school and leisure
time – one of the many teenage carers,
caring for, rather than being cared for; and
the 15-year-old girl having being groomed
for sex and now selling her body. There are
other groups of young people who need a
lot of help as they grow older including
young disabled people becoming
independent, teenagers struggling with
It is naive to assume
that early-years
interventions can
solve the depth of
‘their misery
‘
mental health problems and young people
leaving children’s homes and foster care,
embarking on the journey from care to
adulthood.
Although defying popular and media
stereotypes – such as ‘hoodies’, ‘yobs’ and
‘feral youth’ – teenagers often suffer
greatly: self harming, developing eating
disorders, becoming mentally ill, and,
tragically, some taking their own lives or
being murdered.
A quarter of all Serious Case Reviews
relate to teenagers as victims, and 10%
of these young people are aged 16 or
over. Research by the Prison Reform Trust
shows that young people with leaning
difficulties or mental health problems are
over-represented in the youth justice
system.
However, prioritising early-years
interventions may not only detract from
the emergent problems of teenagers, it
may also diminish their persistent and
entrenched problems which are often a
consequence of the chronic physical, sexual
and emotional abuse experienced within
their families. Every day, professionals are
faced with the reality of helping seriously
damaged young people – some who have
been assisted since they were very young
children. It is naive to assume that earlyyears
interventions can solve the depth of
their misery, and also morally flawed to
deny these young people the help they
need. At the present time teenagers are
already suffering disproportionately in
terms of unemployment. The abolition of
the Educational Maintenance Allowance,
the ending of ring-fencing of Supporting
People funding, cuts in non-statutory
youth services and projects will all further
disadvantage the most vulnerable young
people.
The Coalition Government should
challenge the populist political and
professional consensus surrounding earlyyears
interventions in favour of a far more
comprehensive and wider needs-led
approach to assisting children, young
people and their families. This should
include primary or universal interventions
(such as preventative health, education,
housing, income support), secondary or
early interventions when problems arise at
any age in the lives of young people, not
just early years, and tertiary interventions,
when problems persist.
Prof Mike Stein
Social Policy Research Unit
University of York
Every child’s
beginning
matters
IT IS easy to be distracted by organisational
change and budget challenges, and miss
the important developments that are
happening in children’s public health. From
Marmot to the Graham Allen review there
is an increasing recognition that what
happens in pregnancy and the first years of
life has a major influence on health and
wellbeing in childhood and adult life.
Some of this is familiar, but the more we
find out from neuro-imaging, genetics and
longitudinal studies, the greater the
imperative to do more to give children the
best start in life, whether with parents,
communities or by addressing the wider
social determinants. It also looks as if we
have a better sense of what works and
some cause for optimism that intensive
preventive programmes such as the Family
Nurse Partnership (FNP) have the potential
to improve the outcomes for some of our
most vulnerable children.
It is, therefore, no political fancy or
ideological fashion that lies behind the
Government’s commitment to an
additional 4,200 health visitors or doubling
the capacity of the FNP. There is a
recognition that babies really matter and
that universal as well as targeted
preventive programmes are needed right
from the start. The Healthy Child
Programme is the core universal public
health service for children – but it needs
local public health leadership by experts
who are up-to-date in child public health.
To help build capacity in child public
health, FPH, in partnership with the
Department of Health, will be holding a
professional update in the autumn on
children’s public health in the early years.
Kate Billingham
Project Director
Family Nurse Partnership Programme
Department of Health, England
14 PUBLIC HEALTH TODAY