Saturday, 3 August 2013

Early Intervention … careless talk?

In the wake of the dreadful revelations about the death of Daniel Pelka, it’s not surprising that people should be casting around for quick fixes. The phrase ‘early intervention’ trips off the tongues of many people and certainly no-one can deny that prevention is better than cure. But the concept of ‘early intervention’ is a tricky one and the issues are complex.

Maggie Atkinson, England’s Children’s Commissioner said in a BBC radio interview (which readers in the UK can hear at

“…. maybe it’s time for us to have the conversation about whether it should be a statutory requirement that you intervene early  (my emphasis).

Helen Donohoe, Director of Public Policy, Action for Children is quoted in a press release as saying: 

“…we need to ensure that professionals have all the resources they need-in particular having the ability to intervene as early as possible (again my emphasis). 

I do not know what these speakers intended by their remarks, but there is a danger that they could be interpreted as a call for professionals to have powers to intervene earlier in family lives.  Indeed Maggie Atkinson’s remarks were taken up by Isabel Hardman (a panellist in BBC Radio 4’s ‘Any Questions’ last night - for those in the UK) who said: “… that perhaps there needs to be a statutory obligation to intervene early in these cases, even if it’s removing the child into temporary care so they (professionals) can find out what is going on.”

I have often heard people say that Eileen Munro recommended a statutory duty of early intervention. But Munro is very precise and measured in what she recommends which is:

“The Government should place a duty on local authorities and statutory partners to secure the sufficient provision of local early help services for children, young people and families.” (The Munro Review of Child Protection: Final Report – A child-centred system paragraph 5.27 - - my emphasis)

There is a world of difference between a general duty to provide early help services and taking children into care on a precautionary basis!

I recommend that anybody who wants to come to a better understanding of the issues surrounding what Munro calls ‘early help’ reads Chapter 5 of her final report very carefully. However, there is one important matter which she does not discuss in detail and which I will briefly outline here.

It is the problem of false positives. Statisticians tell us that even if we have quite sophisticated tools for assessing whether or not a member of a population has a certain characteristic (e.g. being at risk of abuse and neglect) where the actual incidence of that problem in the population is quite small, the assessment tool will predict a substantial number of false positives, i.e. instances where the assessment detects the presence of the characteristic in cases in which the problem is not in fact present. Indeed, if the tool is good enough not to miss any true cases, we would expect the number of false positives to exceed the number of true positives. For example screening tests for cancer will generally result in a number of false positives who are then referred for further examination before being given the ‘all-clear’. 

I do not believe that providing ‘early help’ to families that are ‘false positives’ is a problem if the service provided is optional, welcomed by the families and provides genuine assistance to them. For example, being able to attend a Sure Start Centre is something that many families will welcome, regardless of whether or not their children are at risk, because the centre provides services that many families value.

However, other kinds of ‘early intervention’ are quite different – such as Isabel Hardman’s suggestion that some children be removed into temporary care in order to find out what is happening in their families. Not only is such an intervention not likely to be welcomed, it is likely to be extremely harmful in cases of false positives, where some children will be unnecessarily and traumatically removed from people who are, in fact, genuine caring parents.

Indeed it is very difficult to square some types of early intervention with the obligations that we have in international law such as the UN Convention of the Rights of the Child and the European Convention on Human Rights. And I have yet to encounter a good argument against the balance which is struck admirably in the Children Act 1989 where the threshold for statutory action is defined in terms of the ‘likelihood of significant harm’.

So I think we must be very careful when it comes to discussions of ‘early help’ – which I believe must be voluntary and attractive to those to whom it is targeted. We must avoid confusing it with authoritarian forms of ‘early intervention’ that seek to reduce the threshold for statutory intervention.  And we must be absolutely clear that sound arguments for early help do not transform into calls for the state to interfere more widely in family life and to diminish the rights of children and their families.