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Better Systems, Better Chances: a Review of Research and Practice for Prevention and Early Intervention

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Better Systems, Better Chances: a Review of Research and Practice for Prevention and Early Intervention Better Systems, Better Chances: A Review of Research and Practice for Prevention and Early Intervention Dr Stacey Fox, Angela Southwell, Neil Stafford, Dr Rebecca Goodhue, Dr Dianne Jackson, Dr Charlene Smith © 2015 The Australian Research Alliance for Children and Youth (ARACY) owns copyright of all material in this report. You may reproduce this material in unaltered form only (acknowledging the source) for your personal, noncommercial use or use within your organisation. Commercial use of material in this report is prohibited. Except as permitted above you must not copy, adapt, publish, distribute or commercialise any material contained in this publication without ARACY’s permission. ISBN: 978-1-921352-95-9 Disclaimer This report is based on a rapid synthesis of prevention and early intervention research conducted over a 6 week period in April and May 2014. It provides an overview and analysis of key themes and messages from peer-reviewed and grey literature. Readers are advised to consider the most current evidence when selecting and implementing interventions. Suggested citation Fox, S., Southwell, A., Stafford, N., Goodhue, R., Jackson, D. and Smith, C. (2015). Better Systems, Better Chances: A Review of Research and Practice for Prevention and Early Intervention. Canberra: Australian Research Alliance for Children and Youth (ARACY). Contact us If you have any queries about this report, please contact ARACY: Mail: PO Box 5070, Braddon, ACT 2612 Email: [email protected] Website: aracy.org.au Phone: +61 2 6248 2400 @ARACYAustralia ABN 68 100 902 921 Acknowledgements ARACY acknowledges the New South Wales Department of Premier and Cabinet, who originally commissioned the earlier version of this report. ARACY also acknowledges the contribution of Professor John Toumborou, Dr Rachel Leung Jess Hall and Jay Varco in providing background research and analysis for the chapter on risk and protective factors. Table of Contents List of Figures .............................................................................................. iv Executive Summary ...................................................................................... 1 Introduction ................................................................................................ 10 Aims and objectives of the evidence review ........................................................................................ 10 Method and approach .......................................................................................................................... 10 State of the evidence ............................................................................................................................ 10 Prevention and early intervention ........................................................................................................ 12 Importance of systems thinking and proportionate universalism ........................................................ 12 Structure of the report .......................................................................................................................... 15 Part 1: Child Development and Family Wellbeing ...................................... 16 1. Child development: key concepts, frameworks and theories ........... 17 1.1. Overview .................................................................................................................................. 17 1.2. Early brain development – a window of opportunity .............................................................. 17 1.3. Genetics and epigenetics ......................................................................................................... 20 1.4. Child development and adult physical and mental health ...................................................... 21 1.5. Brain development during adolescence .................................................................................. 21 1.6. The impact of disadvantage and inequality ............................................................................. 23 1.7. Developmental pathways - resilience and vulnerability .......................................................... 26 1.8. The impact of parents .............................................................................................................. 28 1.9. The importance of play and home learning environments ..................................................... 31 1.10. The ecological model ............................................................................................................... 32 2. Social and economic benefits of prevention and early intervention . 34 2.1. Overview .................................................................................................................................. 34 2.2. The costs of late intervention and responding to symptoms rather than causes ................... 35 2.3. Estimating cost savings from reducing vulnerability and dysfunction ..................................... 38 2.4. Cost effectiveness of prevention and early intervention approaches ..................................... 38 2.5. Cost-benefit analyses and return on investment in the short term ........................................ 41 2.6. Cost-benefit analyses and return on investment in the longer term ...................................... 43 2.7. The social benefits of prevention and early intervention ........................................................ 48 2.8. Best returns on investment...................................................................................................... 49 2.9. The relative cost effectiveness of universal and targeted services ......................................... 52 2.10. The potential for proportionate universalism to reduce costs ................................................ 53 2.11. Challenges of moving from rhetoric to practice ...................................................................... 54 3. Understanding risk and protective factors ........................................ 56 3.1. Overview .................................................................................................................................. 56 3.2. An overview of risk and protective factors .............................................................................. 57 3.3. Defining risk and protective factors ......................................................................................... 57 3.4. Levels of evidence .................................................................................................................... 58 3.5. An ecological approach ............................................................................................................ 59 Australian Research Alliance for Children and Youth Page | i 3.6. Understanding the processes of risk and resilience ................................................................ 60 3.7. The escalation of risk ............................................................................................................... 62 The snowballing impact of community-level factors on the escalation of risk. ...................... 63 Parent and family-level risk factors.......................................................................................... 64 Toxic stress and trauma ........................................................................................................... 65 3.8. Protective factors for on-track development .......................................................................... 67 3.9. Risk and protective factors by life stage .................................................................................. 70 4. Priority intervention points for child and youth wellbeing ............... 74 4.1. Overview .................................................................................................................................. 74 4.2. Interventions in context ........................................................................................................... 76 4.3. Priority preventive pathways ................................................................................................... 78 4.4. Priority intervention pathways by life stage ............................................................................ 83 4.5. Effective approaches for working with Aboriginal families ..................................................... 97 Examples of programs with emerging evidence .................................................................... 100 Part 2: Systems Design to Support Prevention and Early Intervention .. 102 5. Features of a prevention-focused service system ........................... 103 5.1. Overview ................................................................................................................................ 103 5.2. Availability of evidence and key messages from the literature ............................................. 104 5.3. Rationale for a systems approach .......................................................................................... 106 6. Analysis of existing systems ............................................................ 108 6.1. Overview ................................................................................................................................ 108 6.2. Drivers of engagement and features of effective services .................................................... 111 7. Models and approaches to collaboration and integration
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