The value of investment in the early years
Balancing costs of childhood services
Menzies School of Health Research
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
Northern Territory Government
Early Childhood Series
No. 4 2011
Attribution International 4.0 (CC BY 4.0)
Northern Territory Government
14 THE VALUE OF INVESTMENT IN THE EARLY YEARS: BALANCING COSTS OF CHILDHOOD SERVICES Much more is now understood about factors that enhance the likelihood of successful program rollout to improve developmental outcomes for children. For example, if implementation occurs without linked strategies techniques of dissemination of information; training, laws, mandates and accountability; funding and incentives; and organisational change it is not likely to be successful. 40 Employing dedicated implementation teams can lead to accelerated and effective implementation efforts in a number of sectors. Successful teams are comprised of members who know the program well, know implementation well and understand improvement cycles that combine monitoring and feedback to inform and improve implementation efforts over time. 40 Studies of effective programs have demonstrated that when implementation involves an implementation team, 80% saturation is obtained over three years compared with efforts involving more passive implementation (for example, roll-out of guidelines or provision of information or training alone), which obtain only 14% saturation over seventeen years. 40 While ongoing quality improvement strategies to support practice and incremental service improvement need to continue, passive implementation strategies do not achieve sufficient change in services or sufficiently clear targeting of risk and vulnerability to produce meaningful changes in outcomes. Program fidelity, adherence to a programs specifications for practice and methodology is essential for replicating the effects of evidence-based programs and the ability to attribute those effects to the intervention as implemented. There have been debates about whether or how contextualising or adapting effective programs to suit specific contexts should be allowed. 39 However, it can be argued that adaptation is a condition of successful replication rather than the opposite, that is, some degree of adaptation may be needed if fidelity to the effective change mechanisms of the intervention are to be achieved. 41 It may be tempting to consider picking interventions off the shelf or adapting critical elements of well-known programs in order to be able to locate them in remote Indigenous communities flexibly and at low cost. Such a low-cost solution could involve permitting practitioners to adapt an intervention in any way that is compatible with attracting Indigenous clients to participate in a particular community context. Given the difficulties of practising in remote communities, particularly where the practitioners may be seen as community outsiders, there is often pressure to abandon any prescribed methods or practices in favour of adaptable and seemingly more culturally appropriate strategies. In such cases, implementers would not be able to have confidence that the selected programs would be consistently delivered with sufficient quality and integrity. It would also not be possible to know whether exposure of clients to the selected programs would consistently meet required thresholds of intensity, quality and duration sufficient to cause positive change. For these reasons, fidelity needs to be monitored and supported as a core feature of successful implementation and as a requirement for the evaluation of program outcomes. Nevertheless, the circumstances and characteristics of the NT and its most vulnerable populations are such that no interventions are likely to be simply implemented without proper regard for local contexts. Significant effort will continue to be needed to systemically engage with community leaders and stakeholders in building local program delivery capacity and community understanding of the value of engaging with child development programs and services. This is particularly true when programs are being considered for implementation in communities which have not previously had experience of such programs. 37 43 3.2 Models for effective implementation As already described, the expense of highly targeted and resource-intensive single interventions is considerable and the more expensive the program, the more carefully its target group must be considered. This may work against the feasibility of high-cost, high quality programs in many settings. The cost of provision of comparatively expensive interventions (such as models based on Abecedarian or High/Scope Perry Preschool) in service delivery settings with small eligible populations may require considerable certainty about outcome (for example, verification through an effectiveness trial in a range of community settings) to justify the level of investment required.
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