I spoke in Parliament yesterday about early childhood intervention (my first chance to fulfill the promise I made in my maiden speech to mention randomised policy trials on a regular basis!).
Early Childhood Intervention
18 Nov 2010
Dr LEIGH (Fraser) (12:38 PM) —On 1 November I visited UnitingCare Kippax in West Belconnen and was shown around by Gordon Ramsey and Uniting Care national director, Lin Hatfield Dodds. It was at this time that I was able to familiarise myself with NEWPIN, the New Parent Infant Network, which is a program that aims to increase children’s safety, wellbeing and life opportunities through early intervention. NEWPIN has received considerable praise since its introduction to Australia. I was similarly impressed by the potential of the program to break the transmission of intergenerational disadvantage through the positive construction of social networks and community based involvement.
NEWPIN is a program targeted at disadvantaged families most in need and facing child protection issues. In UnitingCare Kippax, NEWPIN takes place in a setting that aims to mimic a comfortable lounge room and kitchen. The program aims to foster healthy internal relationships by teaching skills such as how to cook a meal with three cranky kids around your feet. It aims to alleviate financial and emotional stress on families and to encourage both cognitive and noncognitive development. At UnitingCare Kippax I was informed that 30 per cent of families served by the centre were Indigenous. Gordon Ramsay told me that their work was ‘fundamentally about hope and reconciliation’. It is also the case that former users of the program in Australia are also being employed by NEWPIN.
We know relatively little about intergenerational patterns of poverty, but we do know that a son whose father is out of work for six months has triple the odds of being long-term unemployed when he grows up and a boy who witnesses parental violence in childhood is six times as likely to hit his spouse in later life. Correlation is not causation, but early experiences seem to matter.
In Australia, our early childhood programs owe a great deal to randomised evaluations of high-impact early childhood intervention programs carried out in the US. There, careful economic evaluations based on randomised trials from the Abecedarian, Perry Preschool and Early Training projects have shown that providing intensive assistance to disadvantaged children and their parents is not just morally right; it can be wildly cost-effective too.
These programs admitted children into preschool at an early age, sometimes as young as four months, and focused on developing cognitive, language and social skills. The target population was extremely disadvantaged. From a young age their IQ scores were below the US average. In the Perry Preschool program, two-thirds of girls in the control group had fallen pregnant in their teens, while more than half the boys had been arrested.
When researchers followed both the treatment groups and the control groups they found that those who received early childhood intervention were doing better on most measures than those in the control group. The programs cost, in Australian dollars, about $15,000 to $50,000 per child, yet they easily paid for themselves in reduced welfare spending, higher tax revenues and less crime. Set against sometimes disappointing results from other antipoverty programs, early childhood interventions look even better.
A program like NEWPIN appears to follow very much in the vein of the Abecedarian, Perry Preschool and Early Training projects. Because it is targeted at a very disadvantaged population, it is potentially extremely cost-effective. For this reason, it would be useful to have a randomised evaluation of an Australian program like NEWPIN. In Australia there have been two small-scale evaluations of NEWPIN but neither—to the best of my knowledge—used random assignment.
This is not because random assignment is impossible. A handful of randomised trials of small early intervention programs have been run by researchers at the University of Queensland, while major early childhood programs are currently undergoing randomised evaluation thanks to researchers at the University of Chicago, Geary Institute at University College Dublin and other institutions.
We should also be reluctant to dismiss randomised trials on the basis that no potentially worthy program should ever be denied to someone. The very reason that a randomised trial denies treatment to those in the control group is that we do not know whether or not the program works. Indeed, anyone concerned about the ethics of random assignment need only look to the NRMA CareFlight team, led by Alan Garner, which has been running the head injury retrieval trial, a randomised evaluation of use of the NRMA CareFlight helicopter.
I commend the hard work of those at Uniting Care Kippax and the promising developments being undertaken through programs such as NEWPIN. I hope that through them we will continue to improve the evidence base around early childhood programs. There is no contradiction between rigorous evaluation and a great sense of hope and optimism about our ability to break the intergenerational poverty cycle once and for all.