Prevention and early intervention to improve outcomes for children and families
A Psychology and Education Professor from the University of Cambridge outlined the importance of addressing and treating mental health problems early on, to help improve childhood outcomes and opportunities later in life.
Gordon Harold, Professor of the Psychology of Education and Mental Health, from the Faculty of Education, delivered a seminar for CSaP’s Policy Leaders Fellows at Newnham College, Cambridge on 4 March 2022. The Fellowship addresses the needs of some of the most senior policymakers across the UK, providing access to research and academic expertise. The programme aims to address the need for long-term thinking, the value of evidence, and fresh perspectives on key challenges.
The presentation began with an overview of mental health, its impacts, and state of research in the field. Prof Harold explained that mental health problems, such as depression, have significantly increased during the COVID-19 pandemic. He revealed that the UK and Ireland have some of the highest rates of depression and poor mental health internationally. And that by 2030, depression will be among the leading causes of morbidity and mortality globally.
“When it comes to prevention and interventions aimed at reducing mental ill health, you must start by understanding how to promote mental health.” - Gordon Harold
Prof Harold noted that the field of mental health has historically followed a “siloed” approach to research and interventions. For example, mental health illnesses were often treated separately depending on whether the disorder was experienced in childhood or adulthood. We now know that many mental health conditions can begin in childhood and continue into adulthood. In fact, according to Prof Harold, 75% of serious psychiatric disorders develop before the age of 18. Therefore, if further intervention and prevention measures of adult psychiatric disorders are targeted early on in childhood or adolescence, it is perhaps possible to avoid one suffering from mental ill health later in adulthood. He emphasised the need to use the term “mental ill health" when we talk about mental health, because, often, we are usually referring to poor mental health. However, understanding the factors which determine mental health, such as wellbeing or happiness, is crucial, especially when talking about the prevention of and effective treatment of mental ill health problems.
Historically, early intervention in childhood referred to interventions which occurred in the first thousand days of life (e.g., promoting secure early attachment models). In this seminar, Prof Harold drew a distinction between early intervention understood as “early in life” and early intervention understood as “early in the life of a risk”. For example, adolescence is a period of elevated risk for depression and anxiety. These problems, if left untreated, could lead to more severe mental health issues in the future. An intervention during adolescence could therefore be considered ‘an early intervention in the life of a risk’, even if it is not ‘early in life’. Prof Harold argued that by shifting the focus to ‘early interventions in the life of a risk’, this can give increased opportunities to target mental health conditions and promote effective early intervention and prevention strategies. For example, he explained that we know that for young people in particular, life transitions are key moments of elevated risk in terms of mental health: transitions into primary school, secondary school, or into higher education, or even into the workplace. These are also key periods for intervention, both to support young people, but also to prevent mental ill health. Prof Harold also noted, adolescence, psychologically speaking, does not stop at the age of 16 and can last up to 25.
“Transitions are a key period where we might intervene, both to support, but also to prevent.”
Returning to the idea of “siloed research”, Prof Harold explained that a particular challenge is that most of the evidence on different intervention strategies are in siloed domains: early years interventions, school-based interventions, and family-based interventions. It is also true that the benefits and consequences of any interventions are not siloed in this way. For example, a family-based intervention can have benefits in the educational context as well. Recognising that interventions in one area can have outcomes and benefits beyond that context is an important policy relevant shift. Prof Harold’s broader point is that we need to move past siloed approaches and recognise that childhood and adolescence overlaps many different domains, such as family, education, and more. However, he said this need to move past the traditional ‘siloing’ of disciplines, interventions, and outcomes presents a challenge to policymaking, since government itself is structured into departments which may not interact or engage to a sufficient degree.
“Longitudinal evidence shows that individuals whose parents have received interparental conflict support, have a lower rate of interpersonal conflict and violence in their own social relationships.”
Prof Harold concluded the seminar by discussing the Reducing Parental Conflict (RPC) programme, a recent policy initiative led by the Department for Work and Pensions (DWP) in the UK. The RPC programme is based on evidence that interparental conflict, especially if frequent, intense and poorly resolved, can have a significant negative impact on children’s mental health and long-term life chances. Targeting interparental relationships can therefore improve childhood outcomes, but also leads to benefits for the parents, as measured by reductions in depression, improved parent-child relationship quality, and improvements in other areas of adult wellbeing - again demonstrating the non-siloed nature of intervention outcomes. Prof Harold presented a cascade framework by which interparental conflict leads to behavioural problems in children, which in turn can lead to academic problems, poor mental health, and ultimately problems in finding or maintaining employment. This emphasises that the outcome of an early intervention can have many interrelated effects. Prof Harold noted that outcomes are implicitly understood as an end, but he argued that outcomes can themselves be the start of a next step. To conclude, Prof Harold said that we should move away from the siloed approach of treating intervention outcomes as an end. Instead, we should recognise the cascade of knock-on effects they produce, and the accumulated costs saved over-time through effective ‘early in the life of a risk’ intervention, and the promotion of future prevention.