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The value of investment in the early years



The value of investment in the early years

Other title

Balancing costs of childhood services


Menzies School of Health Research

Sponsored by

Northern Territory. Department of Education and Training


E-Publications; PublicationNT; E-Books; Early Childhood Series




This publication was produced on behalf of the Department of Education and Training by the Menzies School of Health Research.; Robinson G, Silburn, SR, Arney F, 2011. The value of investment in the early years: Balancing costs of childhood services. Topical paper commissioned for the public consultations on the Northern Territory Early Childhood Plan. Darwin: Northern Territory Government.; Made available via the Publications (Legal Deposit) Act 2004 (NT).




Child development; Early childhood educaton; Northern Territory

Publisher name

Northern Territory Government

Place of publication



Early Childhood Series


No. 4 2011




Attribution International 4.0 (CC BY 4.0)

Copyright owner

Northern Territory Government



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Citation address


Page content

8 THE VALUE OF INVESTMENT IN THE EARLY YEARS: BALANCING COSTS OF CHILDHOOD SERVICES Examples of programs with strong evidence of efficacy and effectiveness include: 12 Enriched early learning programs High/Scope Perry Preschool: enriched intensive half-day, full-week preschool curriculum with home visits, attendance one to two years. Carolina Abecedarian: full-day day care for children aged 6 months to 5 years with enhanced learning activities and regular support for parents. Chicago Child-Parent Centers: half-day, full-year centre-based early education with parent involvement. Parenting and parent/child programs Nurse-Family Partnership: parent home visiting support provided by nurses to low income, first-time mothers; duration antenatal to two years. Triple P Positive Parenting Program: multilevel, multi-age intervention to improve parenting and reduce conduct disorder; includes group and individual components; mode of delivery, duration and intensity vary at different levels. The Incredible Years: multi-component parenting program, targeting parenting training, childrens social skills, and (indirectly) parent-child and teacher-student interaction; trialled with range of social and emotional and clinically diagnosed conduct disorders. Available evidence indicates that not all early childhood programs targeting key outcome domains improved early learning and development; improved school readiness; reduced risk of neglect and abuse; reduced risk of clinically significant disorder are sufficiently effective to generate a positive return on investment over time. For example, although early childhood programs, particularly programs that aim to improve parenting and parental self-efficacy, are often regarded as effective in preventing child abuse and neglect and reducing the need for costly child protection interventions, very few programs claiming to use a home-visiting approach have been shown to be effective. 22 The Elmira Nurse-Family Partnership program demonstrated significant reductions in incidence of neglect and abuse, as well as reductions in presentations at hospitals for injuries or ingestion of poisons during the first two years of life. There were also reductions in placement of children in outof-home care to age 4 years. However, by the fourth year, the differences in state-notified child protection episodes between treatment and controls tended to disappear. 24 The investigators suspected that this was in part because of the greater exposure of treatment families to services and monitoring likely to lead to higher rates of detection than among controls. 23 Another randomised controlled trial of the same nurse home visiting program implemented as a secondary prevention strategy with parents of newborns in families with a history of physical abuse or neglect found that the program did not prevent recurrence of physical abuse and neglect. 25 A systematic review of economic evaluations of the Nurse-Family Partnership programs showed the highest return on investment for the high-risk sample of participants (5.7:1) with the lowest return for the low-risk sample (1.26:1) and a mean for the total sample at 2.88:1 (followed up to 15 years). Another meta-analysis of thirteen studies showed a mean return on investment for high-risk mothers of 2.24:1. 26 However, numerous nurse home visiting trials included in this study (followed up to 4 years only) yielded a barely positive return, leaving the overall outcome to rest on the effectiveness of the quality of delivery of the Nurse-Family Partnership program. It is thus clear that variations in model programs cannot be simply transferred to service settings and community contexts without ensuring program integrity and effectiveness. The evidence is also clear that programs should be appropriately targeted. David Olds, the developer of the nurse home visiting program, has said of the pattern of results of the Elmira study that it: challenges the position that these kinds of intensive programs for targeted at-risk groups ought to be made available on a universal basis. Not only is it likely to be wasteful from an economic standpoint, but it may lead to a dilution of services for those families that need them the most because of insufficient resources to service everyone well. 23 The more expensive the program, the more carefully its target group must be selected. For example, the Abecedarian program, an intensive full-week, full-year day care program, has demonstrated very significant outcomes with substantial cost-benefit ratios. However, it costs far more per participant than other early learning programs and entails significant investment in infrastructure and workforce capacity. 12 13