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
VALUE OF INVESTMENTS IN THE EARLY YEARS: BALANCING COSTS 3 Efficacy. The efficacy of an intervention refers to its capacity to yield benefits without doing harm under optimum conditions. Efficacy trials involve stringent experimental controls, usually randomised controlled trials which enable strong inferences about specific causal mechanisms to be drawn. Some of the most important evidence on outcomes comes from such high quality, stringently controlled trials. Effectiveness. The effectiveness of an intervention refers to its capacity to yield benefits without doing harm under real world conditions, which may include different contexts of service provision, wider and more variable client groups, different management structures, etc., such as are encountered when an intervention is replicated more widely. Effectiveness trials also involve rigorous experimental methods, including randomised controlled trials. The demonstration of the efficacy of an approach under highly controlled conditions is not sufficient to guarantee its effectiveness in all circumstances. An important element of the transfer of research into practice is the demonstration of effectiveness in real world conditions of service provision and clients in actual communities at sufficient scale to be able to demonstrate outcomes of significance for the population. Another important area of cost arises from the impact of unrecognised and untreated, but potentially preventable problems on the effectiveness of services. For example, child conduct problems and difficulties in childrens behavioural adjustment increase demand for high-cost remedial services and are also often followed by more overt non-compliance and antisocial or disruptive behaviour in childrens later school years. These problems in the classroom can negatively affect the quality of the learning environment for all children. Failure to prevent such problems before school and in the early school years is a major factor limiting the efficiency and effectiveness of the school system as a whole and reduces its output (educational attainment) relative to the costs of school education provision. Failure to prevent modifiable problems also has an adverse impact on the provision of remedial services. An important Australian study, the Pathways to Prevention Project, evaluated multiple interventions in a whole of community based on multiple partnerships between non-government organisations, community organisations and a university. 8 It showed that the cost per participant of the multiple interventions of the community-wide project was more than $20,000 below the cost of participation in a remedial reading program that had been adopted by the Queensland Education Department. This study argued that a community-wide program with components addressing social skills, early literacy and family intervention, that diverts even a small number of children from such a remedial service (and services such as intensive behaviour management programs) achieves significant and measurable reductions in costs to society. In a jurisdiction like the NT, where there is significant under-development of many of the specialised services and limited access to existing services outside of the major centres, the importance of developmental prevention programs to reduce the need for more costly remedial services cannot be overstated. However, investment in developmental prevention should not be at the expense of progressive development of remedial services, rather both types of intervention should be on par with services available to children in other states and territories both types of intervention are required. Possibly the most salient cost of inaction in the area of early child development for any society is the failure to realise the developmental potential of all its children, and so to maximise the productivity and wellbeing of the society as a whole. 1.2 Efficacy and effectiveness It is important that the characteristics and strength of the evidence regarding the benefits of early years programs for reducing longer term costs and enhancing social outcomes are more widely understood. This evidence comes from a number of different areas of basic and applied intervention research. Basic research is the body of scientific research on child development that informs understanding of child development, determinants of risk and outcome and causal mechanisms. Basic research supports the formulation of hypotheses, that in turn underpin practices and interventions that are the subject of research trials of the specific interventions. These research trials can then either explore the efficacy or the effectiveness of the interventions or initiatives. 9
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