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3. Early childhood and families

The available literature clearly establishes the benefits of community-based early childhood and family prevention and intervention programs. This includes in terms of both the dollar value of many of the programs, as well as in building stronger and healthier families, and in turn, communities (Greenwood 1999; Bright 1997; Morrison et al. 1997; Tomison &Wise 1999; McCain & Mustard, 1999).

There has been increasing recognition that a child's development in the first few years of life sets the foundation for lifelong learning, behaviour and health (McCain &Mustard 1999; Greenwood 1999). Investment in early childhood development has been found to 'increase the efficiency of primary-school investments and human capital formation, foster valued social behaviour, reduce social welfare costs, stimulate community development, and help mothers become income earners' (Young, 1997, cited in McCain & Mustard 1999, p. 330).

The significance of education in helping to reduce the effects of socio-economic disadvantage and difference has also been emphasised (Tomison &Wise 1999), as has the positive effects of holistic and community-based approaches (Bright 1997; Morrison et al. 1997; 1999; Tomison &Wise 1999; McCain & Mustard 1999).

A note of caution has been consistently made, warning that disadvantages experienced by children, families and the community will not be solved by ameliorative programs alone and that structural causes must also be addressed (Tomison &Wise 1999; Zigler & Styfco 1996; Greenwood 1999; Bright 1997). Further notes of caution have been that the effectiveness of community-based programs should not lead to the replacement of individually-targeted programs (Tomison & Wise 1999; Bright 1997; McCain & Mustard 1999; Zigler & Styfco 1996). Also, while providing prevention services can reduce the need for spending on compensatory and remedial services, not all social expenditures are preventable or can be eliminated. Not all prevention efforts will reach those who need them, or will always be successful with those that they reach (Iowa Kids Count Initiative 1993). The importance of combined, comprehensive approaches consistently underpinned these comments. A range of literature emphasised the need for targeted programs to at-risk groups. At the same time, programs were being expanded to be community-based with aims to change the developmental system and build healthy communities rather than be purely individual-based interventions (Bright 1997; Cox 1997; Morrison et al. 1997, p. 532; Tomison & Wise, 1999).

Over the years, a number of approaches have been developed with increased emphasis on the merits of community-based approaches which foster social networks and strengthen partnerships (Bright 1997; Tomison &Wise 1999). The need to reduce risk factors and strengthen protective (resiliency) factors for children at risk has also been a consistent theme. There has been a groundswell of support for emphasis on holistic prevention strategies and integrated whole-of-community approaches (Watchel 1994; Hay & Jones 1994; United States' (US) Advisory Board on Child Abuse and Neglect 1993; Tomison 1997; New South Wales (NSW) Child Protection Council 1997; National Crime Prevention 1999, cited in Tomison & Wise, 1999, p. 2). There was also broad recognition that coordinated services can better meet the needs of children and their families and stretch available funds through, for example, the pooling of resources (Morrison et al. 1997, p. 531; McCain & Mustard 1999; Tomison & Wise 1999).

Key settings for programs have included—kindergarten, schools, child care centres and other community settings. Of note is that schools were a key community setting for many early childhood and family programs. Programs have focused on a range of areas including early childhood development; child abuse/maltreatment preventions and interventions; education including children at-risk interventions; and family support interventions. Depending on the target group/s, program aims and approaches adopted, there is inevitable overlap among programs in their setting and focus.

Specific program examples are discussed, as well as broad and recurring themes that link with building stronger communities.

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3.1 Early childhood development

The Iowa's Kids Count Initiative (1993, 1995) was part of an effort to develop an Iowa Blueprint Investment Strategy for Iowa's young people. (See chapter 2). The initiative produced a working paper that identified what Iowa social expenditures were preventable and what increased economic activity was possible if very young children started their lives more likely to achieve their full potential. As part of this process, costs that could be associated with a lack of developmental supports and nurturing in the early years were summarised as including:

The Iowa Kids Count Initiative calculated that if prevention initiatives reduced the social costs associated with preventable poor outcomes by just five per cent, then public savings on compensatory, remediation and rehabilitation services, maintenance and basic needs programs and social control and public protection would be more than US$108 million. The estimated savings outweighed the amount invested at that time in prevention and early intervention services by more than five times. The savings would have been even greater if an increased proportion of preventable outcomes were achieved, and/or if other potential gains to society were factored in, such as increased tax revenues from a more skilled and productive workforce (Iowa Kids Count Initiative 1993, 1995).

While few actual cost estimates were available for the specific preventable social expenditures such as those outlined in the Iowa Kids Count Initiative, costs of child abuse and neglect in Australia were obtained. A cost estimate was for annual (1995-96) fiscal and economic expenditure on child abuse and neglect in South Australia (SA) (South Australia Office for Families and Children and the Australian Institute of Family Studies 1999). A lack of specific data relating to inadequate reporting systems meant that economic cost estimates relied heavily on estimates of both the incidence of abuse and actual expenditure.

Only expenditure incurred directly (or likely to be incurred) and immediately attributable to child maltreatment was included, meaning that final calculations did not include expenditures such as for services to adults as a result of their experience of abuse as children. Estimates were made where exact data could not be extracted. The instance of child abuse formally reported was estimated at to be between 0.8 and 1.6 per cent, although it was noted that the incidence of child abuse and neglect is generally recognised to be much greater than those reported. Based on this, an estimate of a five per cent incidence of child abuse and neglect was made, but this was seen as a conservative estimate.

Total expenditure in SA was estimated as $354.92 million. This comprised $51.59 million expenditure for responding to known incidences of child abuse and neglect ($41.41 million) and for expenditure in responding to child abuse and neglect not reported to child protection services ($10.18 million). The costs for responding to abuse-related child deaths, disability, injury and impairment were calculated to be $303.33 million. A comparison is drawn between these total costs and other budget areas, as a measure of the relative magnitude of potential savings through an effective prevention program. It was also noted that child maltreatment absorbs more than the state earned from major exports in wine ($318.46 million) and wool and sheepskin ($239.86) in the same fiscal year.

To help with forecasting future cost estimates, the South Australian report recommends that measures be implemented to improve recording on service demand and expenditure on child abuse and neglect. It also recommends that a minimum additional expenditure of one per cent of the total amount of child maltreatment costs to the state ($3.5 million) be made in an extended prevention program. In terms of potential gains by commercial standards, this was seen to represent a modest investment.

The New South Wales (NSW) Department of Housing produced some social cost estimates for its case study on the Airds neighbourhood (Stubbs & Storer 1996). Some of these costs are cited elsewhere in this report. A cost more relevant to this chapter includes family stress. This was estimated as the direct costs of entry into care and costs per notification incident for the NSW Department of Community Services' Campbelltown Community Service Centre. The annual budget for the centre was taken and divided by the number of children in care to produce a cost of $3 660 per entry into care per child. Similarly, the centre's annual budget less substitute care and cash grants was divided by the number of notifications to provide a cost of $2 215 per notification incident. This then allowed a cost to be calculated for a particular locality based on the unit cost being multiplied by the incidence of notifications for the area.

A summary of a report Investing in Our Children: What we Know and Don't Know about the Costs and Benefits of Early Childhood Interventions is reported on in Greenwood (1999). Unfortunately, the original report could not be obtained for this project and the summary lacked program details. Nevertheless, the summary provides some data worth noting. Through a critical review of relevant literature, the report examined a range of early intervention programs to assess whether targeted children and their families benefited, and whether government funds invested early in the lives of children would yield compensating decreases in government expenditure. This led to the conclusion that early interventions do provide significant benefits to children and their families. The report also made findings that early interventions might save some children and their parents from incurring state expenditures from criminal justice, welfare and other costs (the report did not extend its claims to all types of early interventions). Also noted were limitations of evidence collected to date and how improved evaluations would be of value. Nine programs were reviewed in the report (unfortunately, no program details were provided in the summary paper) and found to lead to the following advantages for participants compared to control group members:

These factors are consistent with outcomes reported, for example the Iowa Kids Count Initiative and other programs reviewed in this chapter.

The Early Years Study

The Early Years Study is a comprehensive, 200-plus page report, commissioned by the Ontario government in 1998 (McCain & Mustard 1999) focusing on children in the early years (aged 0 to 6). The Study sought to learn more about how government, communities and parents could positively affect young people's lives and how young people could be better prepared for life success (in school, their careers and society). Whilst not providing a cost benefit analysis, important background information is provided in this report.

The study sought to learn about how the lives of young children, including those with special needs or at-risk could be enhanced for educational, career and social success. It confirmed that the better the nurturing and learning experience in early childhood involving parents or other primary caregivers, the better the outcomes. These findings covered all socio-economic groups in society. It also found that the early childhood years and childhood development was equal to, or in some cases of greater importance in long-term impacts on people's lives than the time spent in education or post-secondary education. However, it noted that expenditures for early childhood are far outweighed by expenditures for older children and adults.

For example, with the overall provincial expenditure on programs for children up to 18 years in Canada at C$17 billion, the annual average expenditure per child for children up to six was approximately $2 800, compared to approximately $7 250 per year for children aged six to 18. Less than a third of expenditure on the below-six age group was for 'universal' programs, with the remainder for treatment-based programs for children with problems. The study found that the programs lacked a cohesive system to meet the diversity of needs, and that whilst excellent initiatives existed, they did not meet the needs of all families with preschool children. One of the key conclusions was that investment in the earlier years is more cost-effective than remedial programs later in life seeking to address problems stemming from poor early development.

The study outlined key research on brain development and early childhood development, and the effects of the early years on learning, behaviour and health throughout life. It examined the socio-economic context and how Ontario children were faring. The mismatch between opportunity and investment in the early years was highlighted and the importance of building on what is working in communities was discussed.

The study outlined recent early childhood program initiatives and incentives for early childhood development in Ontario (pp. 105-26). Financial details were provided for some programs and incentives, although the examination did not extend to a cost-benefit analysis and insufficient detail was provided to merit their inclusion here. Follow up of these initiatives may be warranted at a later stage.

The study also found that increased community-based initiatives and investment (both public and private) would enhance communities through a range of effective strategies. A number of effective strategies for providing community-based early childhood programs were suggested (pp. 131-45):

The study recommended a comprehensive early childhood development framework involving early childhood development and parenting programs across all socio-economic groups (pp. 147-72).

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3.2 Child abuse/maltreatment

Figures collated by the Australian Institute of Health and Welfare (AIHW) (1999) indicate the incidence of child abuse/maltreatment. For 1997-98, the AIHW estimated child abuse and neglect in Australia to total 98 613 notifications (involving 77 399 children) and 26 025 substantiations (involving 21 772 children). Substantiations varied in severity, ranging from classifications of severe to having causing significant harm, causing moderate harm and posing no further risk. Only cases substantiated by community service departments were included and unreported incidents or incidents reported to other agencies were not included in the data. This indicates that the figures are greater.

The highest proportion of children who were the subject of substantiation was in the age groups 5 to 9 years and 10 to 14 years. A relatively high proportion was also noted for children under one year. Notably, Indigenous children experienced a markedly higher rate of child abuse and neglect for all states and territories except Tasmania. The average rate of 46.4 per 1 000 children aged 0 to 16 years for Indigenous children compared to a rate of 5.6 per 1 000 for other children. Data also indicated that the incidence of child abuse and neglect is greater in sole-parent families. The AIHW saw this as a reflection of the fact that sole parents were more likely to be on low incomes, to be financially stressed and to have less support available in their immediate family. The institute noted other data which suggested that families with low socio-economic status are most likely to be involved in a substantiation of child abuse and neglect.

Child protection orders in Australia were also quantified by the institute and calculated to be 16 449 as at 30 June 1998 (an increase of 731 on the previous year). This equates to a rate of 3.5 children per 1 000 children aged 0 to 17 years. The living arrangements for these children were 85 per cent living in home-based care (34 per cent living in family care (not reimbursed) and 51 per cent living in reimbursed home based care such as foster care); and 15 per cent living in out-of-home care (10 per cent in facility-based care and four per cent living in other arrangements, including independent living). Again, the rate for Indigenous children who were on care and protection orders was 15.5 per 1 000 children and five times the average rate for other children (3.0 per 1 000). Indigenous children were also more likely to be placed in out-of-home care with a rate of 14.2 children per 1 000 in Australia as at 30 June 1998 and more than five times the rate for other children (2.6 per 1 000).

The above figures support the literature on child abuse/maltreatment. Mulroy (1997, cited in Tomison & Wise 1999) noted that child maltreatment is complex and associated with other problems including poverty, mental illness, substance abuse, domestic violence, unemployment and lack of social support. The social problems stemming from child abuse/ maltreatment have also been noted in other research. For example, in the Iowa Kids Count Initiative the consensus among child psychology and development workers was that signs of abuse in the early years are forewarnings of involvement in foster care and juvenile justice systems later on. The initiative also noted that significant numbers (25 to 55 per cent) of institutionalised juvenile offenders had histories of child abuse occurring early in life and that the majority of adult prisoners were from dysfunctional families where consistent support and nurturing was lacking (Iowa Kids Count Initiative 1993). Werner & Smith (1992, cited in McDonald et al. 1997 and Tomison & Wise 1999) identified distinctions between children who overcome risk factors and those who did not in a thirty-year longitudinal study. A relationship with a significant adult family member and a caring relationship with an adult in the community were identified as two critical protective factors that promote resilience among vulnerable children throughout their lives.

To address primary and underpinning issues, a holistic, community-based approach is advocated by Tomison and Wise. It is also advocated as a cost-effective means of service delivery through mechanisms such as pooling of resources. Tomison and Wise (1999) discuss community-based approaches in preventing child maltreatment at length. They outline three theoretical constructs that underpin the development of a holistic approach in recent years in Australia and overseas. These include:

Tomison and Wise (1999, p. 3) refer to some specific Australian initiatives, which develop the concept of resilience as valuable in promoting healthy communities. These include The University of Newcastle Family Action Centre project in collaboration with Professor John DeFrain to develop a measure of resiliency in Australia, as well as the Hawkin and Catalano Communities that Care model implementation in Victoria (see chapter 2).

Sydney neighbourhood study

Whilst not examining any programs in detail that warrant a cost-benefit analysis, Tomison and Wise (1999) do refer to a study with some positive indications of the effects of strong communities. A study by Vinson et al. (1996) of two adjoining neighbourhoods in Sydney is cited. The neighbourhoods were determined as both economically depressed and displaying differing rates of child maltreatment. The study looked at reasons for the differences in child maltreatment rates and found a major difference to be the structure of social networks within the neighbourhood. Parents in the neighbourhood with the higher rate of abuse were found to have less social networks and community links. This, and other research, has emphasised the value of enhancing a sense of community and building networks and informal support systems in the prevention of child abuse and maltreatment (Vinson et al. 1996; United States (US) National Commission on Children 1991, cited in Tomison & Wise 1999).

Similar to the Early Years Study, Tomison and Wise (1999) expand on these themes to note that effective programs to meet the needs of children and families comprise a combined approach involving partnerships. This includes universal services to reduce the effects of maltreatment in early development stages (the earlier the better) through improving parenting skills and reducing risks, and targeting services to those most at risk or who are being maltreated.

The approaches advocated in the above research appear to varying extents in the programs outlined below.

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3.3 Education—school-based programs

School-based programs featured heavily in the literature. Given that every child links with the school system and schools are the primary place for families with school-age children to meet and interact, this is not surprising. Tomison and Wise (1999) noted that schools offer a key setting for the prevention of social ills and general health promotion. McDonald et al. (1997) noted that low-income families could be provided opportunities through schools to become contributing members of the community.

The High/Scope Perry Preschool Study and Project Head Start

It would be remiss not to mention two of the earliest intervention programs—the High/Scope Perry Preschool Study and Project Head Start. Despite originating more than thirty years ago, these continue to be cited in literature as best practice models or significantly influencing the development of early intervention programs (McCain & Mustard 1999; Bright 1997; Iowa Kids Count Initiative 1993; Tomison & Wise 1999) and Project Head Start (McCain & Mustard 1999; Tomison &Wise 1999). Both projects have been extensively reviewed and evaluated including a cost-benefit analysis of the Perry Project with very positive results. Brief details for each project are provided below.

High/Scope Perry Preschool Study

This study is widely referenced by others in the field, noting that it is a program that has significantly shaped early intervention strategies (Tomison & Wise 1999, p. 7). It is one of the few studies to have examined the link between preschool education and reduced delinquency (Bright 1997 p. 50) and developed estimates of the cost-effectiveness of high quality early childhood development programs (Iowa Kids Count Initiative 1993, p.21).

The Perry Study was a preschool education program that commenced in the early 1960s with a curriculum focus that enabled children to participate in an active approach to learning, facilitated by well-trained teachers. To reinforce the school curriculum at home, home visiting was another component of the program.

Longitudinal studies of program participants were undertaken at age 19 and at age 27. The reported outcomes included an increased proportion of young people who were literate, employed and enrolled in post-secondary education and a reduced proportion of young people who needed special education services, had left school, were arrested, had become a teenage mother or were on welfare. Program participants were also found to have a greater earning capacity and be more likely to be homeowners (Iowa Kids Count Initiative 1993, p. 22; Bright 1997, p. 50; Tomison & Wise 1999, p. 8). Schweinhart (1987, cited in Potas et al. 1990) estimated that the total benefits in 1981 dollars were approximately US$28 000 per participant, or approximately six times the cost of a one- year program and three times the cost of a two-year program. This was supported by other work by Schweinhart et al. (1993, cited in Bright 1997, and Tomison & Wise 1999). A cost- benefit analysis quantifying the impact of social costs estimated that, by the time children involved in the study had reached 19 years, there had been a return of $4 for every $1 spent on early childhood services. This return on investment became even greater when calculated at 27 years. At this age, the estimated savings of those less likely to require special education services were more than $7 for every $1 of taxpayers' money spent on the preschool program (Barnett 1993, cited in Tomison &Wise 1999; Schweinhart & Weikart 1993, cited in the Iowa Kids Count Initiative 1993). Barnett and Escobar (1987, cited Zigler & Styfco 1993) estimated the per-child cost of the Perry School Project to be US$6 300 in 1986 dollars.

The Iowa Kids Count Initiative offered a cautionery note on the benefits of high-quality preschool programs. It stated that such programs (including Project Head Start, below) are only part of the solution to achieving school readiness and are not a solution for all children or families involved in such programs. It also found that the most gains were to be found in programs that also included an active parent involvement program.

Project Head Start

Project Head Start commenced in 1965 with to give disadvantaged preschool children aged three to five years a 'head start' to help them commence elementary school with competence levels similar to their middle-class peers. The program had an initial enrolment of more than 500 000 children. Early studies of Head Start focused on improvements to children's intelligence test scores. The findings were that while children who attend preschool increase their IQ score for some years, this boost eventually fades. However, lasting effects were found in other areas. These included that children were less likely to be referred to special education classes or to repeat a grade in school (Zigler & Styfco 1993). Another Head Start study found that children had better health, better immunization rates and nutrition and improved socio-economic circumstances (McKey et al. 1985, cited in Zigler & Styfco 1993). Other studies showed better school adjustment for Head Start participants, as well as fewer school absences and improved academic performance (Copple et al. 1987, and Hebbeler 1985, cited in Zigler & Styfco, 1993).

Zigler and Styfco (1993) and (1996, cited in Tomison & Wise 1999) noted a number of the outcomes and cost-benefits identified in the Perry School Project. These included savings to society from reduced special education; reduced grade repeats; reduced usage of welfare and criminal justice systems; and contributions to the tax base from higher unemployment). These outcomes and cost-benefits have also been inferred to Head Start and other early intervention programs. Zigler (1993, p. 12) noted that 'although it is somewhat difficult to extrapolate the likely effects of individual Head Start programs …the salient effects of high-quality programs are sufficiently consistent to permit an inference of at least broad developmental benefit'. However, Zigler and Styfco (1993) did note that the attributing the Perry School Projects' reports of $7 savings for every $1 invested to Head Start appears to be in part because of media elaboration. It was also noted that findings for the Head Start program were too modest or that data were lacking on program outcomes to make such direct correlations (Haskins 1989; Woodhead 1988). Zigler (1996) noted that based on positive evidence, Head Start-like programs have seen a resurgence in the US as half-day programs during a school year with some children attending for over two years. No cost-benefit analyses of Head Start Projects (original or current) were cited. Barnett and Escobar (1987, cited in Zigler and Styfco 1993) estimated the per-child cost of Head Start in 1990 to be US$2 767 . The lesser expenditure per child for Head Start compared to the Perry Project was considered a key reason why Head Start had not achieved the extent of outcomes that the Perry Project had (Zigler & Styfco 1993).

Families and Schools Together—Australia and the United States

Families and Schools Together (FAST) is a collaborative, school-based early intervention program for children and families. The program is a multi-family, community-based approach originating in the US in 1988 through Dr Lynn McDonald (McDonald et al. 1997; McDonald & Sayger 1998; Coote 1999). It has been implemented in over four hundred school sites throughout the world, including twenty-seven US states, Australia (nine Victorian primary schools), Canada, Germany and Austria. Pilot projects are planned for Queensland, the Australian Capital Territory and Western Australia in 2000 (Coote, 1999).

FAST aims to build resiliency and protective factors for children. Primary-school children aged four to nine years identified within the school system as being at-risk are targeted (if showing underlying risk factors of school failure, child abuse, substance abuse and delinquency). FAST also targets the children's families. FAST involves the collaboration of schools, parents, family support and alcohol and drug agencies over an intensive eight-week program involving volunteer families in strategies and activities involving individuals, families, parents and school-community networks. The first stage of the program commences with teachers identifying at-risk children and home visits to identified families are undertaken to encourage program participation. The eight-week program is followed up with a two-year FASTWORKS program—a series of monthly family-support meetings designed to maintain an active social network. Staff in the program are also available in between weekly sessions and families sometimes offer contact details to each other for contact in-between and beyond the program. McDonald notes that parent graduates are used to help with future programs. This facilitates ongoing skills' formation as well as job creation. Noted outcomes of participants' involvement in FASTWORKS have included increased community involvement and the emergence of community leaders. The formation and maintenance of strong and ongoing social networks and the building of a sense of community have also been observed (McDonald et al. 1997). Parent testimonies also recognised FAST as having contributed to the pursuit of further education and to obtaining employment (McDonald et al. 1997).

Typically 10 to 15 families participate in a FAST program, involving thirty to fifty adults and children per weekly session. Tangible participation incentives are incorporated in the program including transport, a meal and child care.

FAST seeks to develop a support network for the family and to empower parents to be the primary prevention agent for their child. It has also been designed to promote educational achievement, strengthen family bonds and relationships and build communities. Other goals were identified as fostering feelings of affiliation, and mutual respect and reciprocity among the children's family, school and community environments (McDonald et al. 1997).

Evaluation results are highly positive, showing significant decreases in children's identified behaviour problems (including anxiety/withdrawal and attention-span problems). According to both parents and teachers (an improvement of 20 to 25 per cent in behaviour was calculated) (McDonald & Frey 1999). Another behaviour-related finding was that parents reported that the improvement in their child's behaviour was maintained or improved two to four years after the FAST program had been completed (McDonald et al. 1997). Other program findings by McDonald et al. (1997) included:

The nature of community involvement by program participants since FAST included 30 per cent in full-time employment; 24 per cent in part-time employment; 44 per cent in further education; 14 per cent in volunteer organisations; 35 per cent in a community center; 32 per cent in church; 17 per cent in a parent-teacher organisation; 26 per cent in counseling; and eight per cent in alcohol or substance abuse treatment. Based on responses by the families involved, improved family cohesion (reduced family conflict and increased expressive play time) was another reported outcome.

Australian data shows high participation and retention rates, with data showing that the program will be completed by 94 per cent of those attending the first session (McDonald & Sayger 1998). This compared to an 88 per cent retention rate for the US (McDonald et al. 1997).

Follow up was made with Coote to elicit more costs details. Funding sources in Australia have been through charitable trust grants. Coote provided cost estimates showing that the cost to operate FAST in one primary school range from $32 000 to $49 000 including costs for the two-year follow up program. Other variables affecting cost include the number of FAST team members (maximum is ten, minimum is four) and whether FAST team members are paid to work on the FAST team or require additional payment for the out-of-hours work involved. Depending on how the program was staffed, Coote advised that estimated Australian costs are an average of $38 000 or less. This was the cost for the program (over two years) for servicing between 20 families (up to 30 children attending with parents) and 30 families (up to 60 children attending with parents). The cost per family unit was estimated to range from $1 266 to $1 900 per family over two years.

McDonald and Frey also provided a cost analysis, reporting that the cost per family is approximately US$1 200 for eighty-six hours of services (30 sessions, including FASTWORKS) over two years. The cost for each school offering two FAST cycles per year to serve 30 families was calculated as US$30 000 (not including evaluation of FASTWORKS) (1999).

Better Beginnings, Better Futures

This project was discussed in the Early Years Study (1999, pp. 110-11) and further information was obtained via a web search (http://www.opc.on.ca/bbbf/index.html). The project is a 25-year longitudinal prevention policy research demonstration project being implemented in 12 communities across Ontario, Canada. Its aim is to prevent young children in low-income, high-risk neighbourhoods from experiencing poor developmental outcomes that then require expensive health, education and social services.

Better Beginnings, Better Futures is a holistic and integrated program provided initially in eight, and later 12 communities, targeted at economically-disadvantaged and high-risk children aged 0 to 8 years. Program components include child and parent-focused components and community-focused initiatives with the aim of:

Project funds stem from a range of government sources totalling $6.64 million per year in 1999. The program recently completed a five-year demonstration project. Comprehensive data were to be available in 1999 although was not attainable for this project. Children involved are to be monitored as a part of a twenty five-year longitudinal research study to see if they fare better than equally disadvantaged children not participating in the prevention programs. Anticipated long-term program outcomes are that children involved will require fewer expensive services, be less likely to be in trouble with the law, less likely to become pregnant as teens, more likely to stay in school and be healthy, and more likely to be employed as adults. Shorter-term outcomes are predicted to be that fewer children will require expensive protection and treatment services, be less likely to require special school services and less likely to have chronic illness and injury.

Success for All Program

Success for All was a school-based achievement-oriented program for disadvantaged students from kindergarten to grade five which originated from a partnership between Baltimore Public Schools and the Centre for Research on Elementary to Middle Schools (Balkcom & Himmelfarb 1993). The program was based on the views that every child can learn and that early success is crucial for later success and that intervention can alleviate learning problems and effective school interventions are comprehensive and intensive. The program sought to:

The program involved a family support team working to promote parent involvement and build child resiliency. Other services (community and mental health) were provided as necessary. As at 1993, the program had been implemented in 50 schools in 15 states in the US. Program results included improved performance by some children, reduced special education placements and improved retention rates. For example, 3.9 per cent of third-grade students in the program performed two years below grade level, compared with 11.7 per cent of the matched control-group students. Savings in students not repeating a grade and special education placements were found to offset the annual per student cost—an additional US$800 to the school's usual allowance per student.

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3.4 Family support interventions

Family support interventions were discussed by Bright (1997) and noted to be effective strategies for averting social and community problems. Family supports include crisis interventions, less intensive supports for families in difficulty, parenting programs and/or a mixture of programs. Targets are families, particularly those at greatest risk, including, those who are poor and socially isolated. Bright noted research findings linking isolated families with factors such as abuse and neglect, school failure, truancy and delinquency (Schorr 1988, cited in Bright, 1997). The benefits of family support interventions can include reduced foster care and out-of-home placements as well as improved parenting, reduced child abuse, improved school achievement and reduced delinquency. For example, Bright referred to programs in the US that claimed substantial reductions in foster care and other out-of-home placements with cost effectiveness estimates of a return of between $5 and $6 on every $1 invested through reduced long-term foster care, group case or psychiatric hospitalisation (p. 48). Bright noted that improved parenting and reduced out-of-home placements could be expected to reduce later offending patterns. He noted that while this has yet to be proven by longitudinal studies, knowledge of family discord and breakdown and its association with delinquency were reasonable indicators for this conclusion. Bright also noted that action to address outside stresses such as poverty and unemployment which make it difficult to be a 'good' parent, would help family support interventions achieve their full potential.

Homestart

A United Kingdom (UK) program called Homestart was referred to which aimed to reduce family breakdown through using trained volunteers to support families with preschool children. A positive evaluation was reported with 86 per cent of children registered as at-risk staying out of care (Van der Eyken 1982, cited in Bright 1997). Bright noted that fully attributing these results to Homestart was not possible. Financial details were not provided, which precludes a cost-benefit analysis at this stage.

Provence group approach

The Provence group approach is a US-based program discussed by Seitz et al. as part of a longitudinal analysis of the program (1985). The program involved coordinated social and medical services (including social work, paediatric care, day care and psychological services) to disadvantaged mothers and included day care for their children. The program began during the mother's pregnancy and continued for 30 months after the birth. The program costs were US$7 500 per family in 1970-72 dollars over the 30-month intervention period. These were calculated to translate to approximately US$20 000 in 1982 dollars.

A 10-year longitudinal study produced findings that supported findings from a five-year follow up. These were that the program contributed to significant changes to parents and the interventions had lasting consequences for the families' socio-economic status. The 10-year study compared program participants (mothers and children) to a control group. Its findings included that mothers involved in the program were more likely to be self-supporting (almost all of the program families were compared to about half of the control group families). Program families were smaller—this was believed to be significant in the higher education levels achieved by program mothers (through delays in subsequent childbearing allowing a return to education) compared to the control group. The study also found that mother-child relationships were better in program families than control families. Also it found that program mothers were more active in the school and their child's education. The children involved in the program were found to have better school attendance (an average of 7.3 days absence for program participants compared to 13.3 days absence for the control group). It was also found that boys in the program were less likely to need costly special school services (average service costs for program participants were US$450 per child compared to US$1 570 per child for the control group).

Over the ten years, an estimated US$40, 000 additional welfare costs in 1982 dollars and documented school service costs were calculated as needed each year by the 15 families in the control group. This led to the conclusion that the program was paying itself off at the rate of at least two families per year. The study also concluded that providing services over a long time does not necessarily lead to dependence (as evidenced by the increased self-reliance of program families). Other conclusions of the study were that programs designed to address combinations of problems were likely to be more effective and that comprehensiveness and coordination should therefore be an element of all family support intervention.

K-Six Early Intervention Partnership

This was a school-based program serving high-risk families through an early intervention, family-centred approach developed in 1984 by a community task force studying high school drop outs. The program was piloted in two schools and later adopted by Fresno Tomorrow, Inc. (a youth services collaborative) and expanded.

The program sought to increase academic and social literacy; promote regular school attendance; reduce chronic transiency; strengthen family functioning; empower parents to serve as effective partners in education; increase community accountability for children; identify fiscal and regulatory barriers to the provision of services; and demonstrate effective means to overcome those barriers. The program involved the cooperation of several agencies using pooled funds (public and private) to provide services and case management to families. Families were identified as high-risk by teacher and parent input and computer analysis. Agency workers (Department of Social Services, social workers, mental health specialists and juvenile probation officers) formed a team with school-based workers. The program involved support and incentives provided at home and in the school in a range of areas including attendance incentives; community and family advocacy; cross-age tutoring; cultural enrichment; family literacy training; mentoring; parent involvement workshops; parenting and household management education and training; and parent and child support groups and recreation.

Positive outcomes were reported for the program. This included referrals for misbehaviour among the children involved reduced by 70 per cent per child; increased parent-initiated contact with the school (from two contacts a year to two contacts a month); a 40 per cent reduction in unexcused absences; and reduced high school drop outs and reduced teenage pregnancy (nil drop outs or pregnancies among the 60 children involved in the program and now in high school).

Fresno Tomorrow, Inc. coordinated the K-Six Program and was funded by the Annie E. Casey Foundation. The Program had an overall budget of US$1.2 million and the cost per family for services was estimated to be US$375.

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3.5 Early childhood and Families—conclusions

The literature reviewed in this chapter clearly establishes the benefits of community-based early childhood and family intervention and prevention programs. The benefits arise from both the cost effectivenes of many of the programs as well as in building stronger and healthier families and, in turn, stronger and healthier communities. As in medicine, prevention is far more effective than remedial action. The premise for early childhood prevention and early intervention programs is the recognition that a child's development in the first few years of life sets the foundation for lifelong learning, behaviour and health outcomes.

From this literature review, it is apparent that a combined approach which links community- based programs with individual prevention and ameliorative programs targeted at 'at-risk' children provide superior outcomes. Similar conclusions can be drawn for family support programs. This is because community-based programs build resilience and protective factors which address the structural causes of disadvantage in ways which are not addressed by individual programs alone. By building social networks and empowering communities, self- reliance and protective factors are strengthened (and there is some evidence that dependency on individual programs is thereby reduced). Because of the complexity and multi-dimensional nature of many social problems affecting children and families (for example,. child abuse, maltreatment, and so on), community-based initiatives that are integrated with government programs, and which address combinations of problems, are likely to produce more socially and cost-effective results.

The studies show the importance of prevention and intervention programs that are initiated early in the child's life. When programs are directed at families with children who have yet to complete primary school, they are more effective in terms of social outcomes (such as reduced substance abuse, reduced maltreatment, reduced future involvement with the justice system, increased school completion rates, future employment and so on). They are also considerably more cost effective in terms of program expenditure per participant. The importance of education and schools is emphasised, as is the importance of the active involvement of parents and other primary care givers.

Table 2: Summary of early childhood/family programs received
Program/ Project Title Program/ Project Description1 Target Community/ Group2 Funding sources Project Costs3 Outcomes4 Evaluation5 Contact Details

High/Scope Perry Preschool Study: Ypsilanti Perry Preschool Project

A two-year preschool program to enable children from disadvantaged backgrounds to participate in an active approach to learning. Undertaken in Ypsilanti, Michigan from September 1962 to June 1967.

Preschool aged children from disadvantaged backgrounds.

State funds (Michigan).

Social indicators: Over the long term—reduced crime; reduced welfare dependency; increased literacy; improved school retention rates; reduced long-term unemployment; reduced teenage pregnancy; increased social capital.

Short-term and longitudinal studies, including cost benefit analysis and comparison of program participants with control groups. Cost-benefits over the long term; a saving of $7 for every $1 invested in the preschool program at the time participants were 27 years old. The estimated program cost per child was US$6 300 in 1986 dollars.

No longer current.

Project Head Start

A preschool program run throughout the US to help disadvantaged preschool children get a 'head start'by starting elementary school with competence levels similar to their peers. Originally commenced in 1965, it has continued since in various forms throughout the US.

Preschool children aged three to five years from disadvantaged backgrounds.

Various US funding sources.

The outcomes and cost-benefits for the Perry Preschool Project (above) have been generalised to Head Start, including positive long term effects on the child's ability to meet academic and social expectancies. Social indicators specific to Head Start: improved school retention; reduced referrals to special education classes; better health outcomes; better immunisation rates; better nutrition and improved socio-economic circumstances.

Various short-term and longitudinal studies. Similar cost-benefits to the Perry Preschool Project (above) have been extrapolated to Head Start although with some caution. The estimated program cost per child was US$2 767 in 1990 dollars.

No longer current.

Families and Schools Together— Australia and US.

A two-year, school-based early intervention program for children and families to build resiliency and protective factors for children through an eight-week intensive course, followed up by a two-year program involving monthly self-help meetings and ongoing family support. The program has been operated in various locations including the US, Canada, Australia, Germany and Austria.

At risk children aged four to nine years.

Australia—charitable trust grants. Cost to operate FAST in one primary school is estimated to cost from $32 000 to $49 000 (including two-year follow up program costs). USævarious funding sources. Estimated cost per school for two FAST cycles per year was US$30 000 (not including FASTWOKS evaluation).

Social indicators: decreases in identified behaviour problems of children (sustained over two to four years); increased child and parental self esteem; improved educational success; improved family cohesion; increased parental involvement in their child's schooling; increased higher education participation of parents; increased employment for some parents (including as program workers after graduation from the program).

Stronger communities' indictors: networks and partnerships in communities; knowledge and skills including volunteering; leadership in communities.

Qualitative and quantitative evaluation built into each program. Various evaluations have been reported upon including in the US and Australia— short-term and longitudinal. Some cost data is available. For example, average cost per family over two-year program for Australia was estimated to be from $1 266 to $1 900 and for the US approximately US$1 200).

Australia:Sherrie Coote, FAST International— Australia, (Ph: 03 9481 4915), (e-mail: scoote@tig.com.au). US: Dr Lynn McDonald, Program Founder, The FAST Research Project, Michigan (Ph: 608 263 9476), (e-mail: mrmcdona@facstaff.wisc.edu).

Better Beginnings, Better Futures

A twenty-five year longitudinal prevention policy research demonstration project across twelve communities in Ontario, Canada with the aim of preventing young children in low-income, high-risk neighbourhoods experiencing poor developmental outcomes which then require expensive health, education and social services.

At risk children aged 0 to 8 years.

Ministry of Community and Social Services; Ministry of Health; Ministry of Education and Training; Federal Department of Indian and Northern Affairs; and Heritage Canada. Total program funds in 1999 were C$6.64 million.

Social indicators: reduced crime; reduced welfare dependency; better health outcomes; reduced long-term unemployment.

A five-year evaluation was completed in 1999 (not available for this report). Future evaluations are planned to assess effectiveness and cost-benefits of the prevention model.

Carol Crill Russell, Senior Research and Policy Advisor, Children's Services Branch, Ontario Ministry of Community and Social Services, 4thFloor Hepburn Block, 80 Grosvenor St, Toronto, ON M&A 1E9. Ph: 416-325-5329.

Success for All

A school-based achievement-oriented program involving a family support team. The program aimed to promote parental involvement and build child resiliency through improved reading skills; reduced special education referrals and repeated grades; increased school attendance; and addressing family needs (food, housing, medical care). Originated in Baltimore, US and later extended to various US locations.

For disadvantaged students from kindergarten to grade five.

Not available in literature cited.

Social indicators: reduced welfare dependency; increased social capital.

Program evaluation undertaken including an estimated US$800 cost per student additional to a school's usual allowance. Savings in grades not being repeated and reduced special education placements were calculated to offset program costs.

Robert Slavin, Centre for Research on Effective Schooling for Disadvantaged Students, The John Hopkins University, 3505 North Charles Street, Baltimore, MD 21218. Ph: 410-516-0274.

Homestart

A UK volunteer support program to families with preschool children aiming to reduce family breakdown.

Families to preschool children.

Not available in literature cited.

Social indicators: reduced welfare dependency; increased social capital.

Stronger communities' indicators: knowledge and skills; including volunteering.

Evaluation undertaken. No cost-benefit details available in the literature cited.

Not known.

Provence group approach

A one-off US-based program (New Haven, Hamden and West Haven, Connecticut) involving coordinated social and medical services to disadvantaged mothers and their children.

Disadvantaged mothers from pregnancy to 30 months after birth.

Not available in literature cited.

Social indicators: reduced welfare dependency; increased social capital.

Stronger communities' indicators: local solutions to local problems.

Evaluations including a five-year follow up and a ten-year longitudinal study. Cost estimates of the program include: US$7 500 (in 1970-72 dollars) or US$20 000 (in 1982 dollars) per family. Welfare and services savings of US$40 000 (in 1982 dollars) estimated for families in the program compared to a control group.

Not known.

K-Six Early Intervention Partnership

A school-based early intervention program which sought to increase academic and social literacy; improve school attendance; reduce chronic transiency; strengthen family functioning; empower parents; and identify and develop means to overcome barriers to service provision. Piloted in Fresno, California and expanded to other locations in the US.

High-risk families.

Annie E. Casey Foundation.

Social indicators: reduced crime; better health outcomes; increased social capital.

Strong communities' indicators: networks and partnerships in communities; local solutions to local problems.

Qualitative and quantitative evaluation. Cost estimates; overall program budget US$1.2 million. Estimated program cost per family—US$375.

Jeff Stover, Executive Director, Fresno Tomorrow Inc., Fresno Executive Plaza, 1900 Mariposa Mall, A-301, Fresno, CA 93721. Ph: 209-442-3342.

1. Description of project aima and location. Pilot, one-off, or on-going. Project length.

2. By geographic location/region and/or community of interest.

3. Name of funding program/s or funding sources, total project costs (direct and indirect).

4. General effectiveness/outcomes as well as social indicators and stronger communities indicators.

5. Quantitative and/or qualitative evaluation. Availability of cost-benefit data

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4. Young people

2. Community wellbeing