Viewpoint: A better start in life?

Dr Hannah Levis, Reader in Ophthalmic Bioengineering, Eye & Vision Sciences

Caroline Rowland is Professor of Developmental Psychology in the Institute of Psychology, Health and Society and a co-Director of the new ESRC International Centre for Language and Communicative Development

“Today, the Big Lottery Fund announced a £215 million project to give 60,000 vulnerable babies a better start in life. The Better Start campaign targets three key areas of child development – social and emotional development, nutrition, and language and communication development – on the understanding that improving babies’ lives in these three areas will give them the best possible chances in life.

“This initiative is heartily to be welcomed. The most cost-effective way to tackle the root causes of many social, economic and educational problems is to intervene early in children’s lives, before the problems have a chance to entrench.  And by putting language and communicative development at the heart of the initiative, the Better Start campaign is recognising what we researchers know already – that children who enter school with good language skills have better chances in school, better chances of entering higher education, and better economic success in adulthood.

“However, recognising the problem is a far cry from doing something effective to tackle it, especially in the so-called age of austerity. It’s easy to tell busy working parents to sit down and read with their 2-year-old every day, but it is a lot harder (and more expensive) to work with them to fit this into their schedule, and even harder to motivate them to keep it going for years.

“This is why I was so pleased to see that the Better Start campaign will focus on testing the effectiveness of different interventions, rather than simply applying a particular technique and hoping for the best. For example, in Nottingham, they will focus on tackling home-life stressors such as domestic abuse and substance misuse, in Bradford, they will focus on reducing midwife caseloads to allow for more personalised care, and in Lambeth, they will establish 50 new community champions to provide help and advice in the community.

“We sorely need these studies because we are sadly lacking a good evidence-base of what works in early years interventions. The Communication Trust’s What Works database is a wonderful resource of 60 interventions used by professionals to improve the language skills of children across the UK but only 3 of them (5%) have been awarded a ‘Strong’ evidence rating.    In other words, 95% of the interventions used in clinics, schools and nurseries today might not actually work at all.

“Even the Every Child a Talker (ECaT) programme – the last government’s £40 million initiative to train early years educators in speech and language development – has never been evaluated in a peer reviewed, published study, as far as I can see.  I’m sure that, if assessed, it would have positive outcomes. Reading the government reports, it looks like it might reduce the number of children identified as at risk of language delay. But since this evidence has not been scrutinised, evaluated and, most importantly, published in a peer review journal, I can’t provide you with a cast iron guarantee that it works. So I send out a plea to the researchers and practitioners involved in the Better Start campaigns to design their studies carefully and to publish their results in academic journals, to provide us with a really robust evidence-base of what does and doesn’t work.

“You may ask, does this really matter?  If teachers, midwives or therapists like a particular intervention, do we really need a robust evidence-base of research to test if they are right?  Yes we do.  With the best will in the world, professional opinion is no substitute for a randomised controlled trial or systematic review. This is not because professionals are stupid, uneducated or lazy.  In fact, it is because they are intelligent, educated and dedicated.  Health and education professionals make a difference to children’s lives simply by being skilled, experienced and enthusiastic about learning, whatever intervention they use.  In order to figure out what really works, we need randomised controlled trials, conducted over different sites, with different practitioners – both those who are, and who aren’t, enthusiastic about the intervention.

“Let’s take an analogy.  Say your GP gave you a drug, telling you “there’s no actual evidence that this works, and it’s quite expensive, but I quite like it and some of my patients swear by it”. I doubt you would be happy. Shouldn’t we apply the same standards to our children’s development? That way we can be sure that we really are giving them a Better Start in life.”

Listen to Radio 4’s Today programme discussing Heritage Lottery funding for vulnerable babies, here

Leave a comment