What is the best way to promote early child and family support in a city, region or country?

Part 1: Problems with the top-down approach

Preamble

This essay concerns babies and pre-school children who have conditions that can present significant obstacles to their development and learning. A child might have a single condition (with a single diagnosis) or a multifaceted condition (with two or more diagnoses). The essay is intended for all people who care for or support these children as parents, family members, practitioners, managers and for academics.

I am avoiding using the words ‘disabled’ and ‘disability’ because I feel they are premature and discriminatory in such young children and can promote negative mind-sets in children and the adults around them. I also discount the term ‘developmental delay’ because this implies children will eventually catch up with their peers. For very many children this will not be so. I also am avoiding the phrase ‘early childhood intervention’ because it does not suggest equal partnership between families and practitioners. I prefer ‘early child and family support’ because it sounds less intrusive and authoritative and helps bring the work into the modern era.

The aim of the essay is to aid discussion about how to initiate or enhance effective integrated early child and family support in a city, region or country. ‘Effective’ is not an easy word to define when families and their situations, children and their conditions and successful approaches are all unique and conform to no universal standards. My working definition for an effective service is a service that comes when needed, addresses issues and concerns that are relevant to the child and family and leaves the family feeling they have received, as far as practically possible, the support they needed and/or asked for.

‘Integrated’ is an easier word to define. Support around a child and family is integrated when the main people offering regular and practical support find ways to join their work together regardless of what their discipline is or which agency they work for. Team Around the Child (TAC) is one successful example of this multidisciplinary and multiagency integration. Integration at a higher level is essential in building a TAC System for a city, region or country. In this, senior people from relevant departments and agencies find ways to join their work together to encourage, facilitate and support integrated teamwork around each child and family in their locality.*

In my view, the world is making very slow progress in the imperative to provide effective integrated early child and family support to the majority of families in the majority of countries. My negative assessment includes high economy, middle economy and low economy countries and I believe all countries have something to offer in finding ways forward. My negative assessment also includes children who begin life under very disadvantageous circumstances. Included here are children in oppressed minorities, children in displaced populations and children of oppressed first nation peoples. Our best efforts to provide early child and family support in a city, region or country often fail to consider these children and their families.

This essay is not about reasons for this slow progress but, briefly, my reasons would include:

Widespread prejudice about people with disabilities and lack of concern for them in the general population.
A general lack of appreciation of the importance of the early years in every child’s life.
A general failure to acknowledge the high impact these children can have on their families in terms of physical health, mental health and economy.

The essay is suggesting we have not yet found successful ways to promote effective integrated early child and family support. Millions of children and families, now and in the future, will have to remain unsupported if we cannot improve what we are doing and move at a much faster rate. I am going to describe three approaches, the first two of which I have extensive experience of. The third can be seen as a synthesis of elements of the first two with some new thinking. These are:

A top-down approach in the typical vertically organised hierarchies
The approach Interconnections uses internationally to promote TAC
Empowerment of people at the grassroots to effect change

The second and third of these will be addresses in the following parts of this essay.

A top-down approach in typical vertically organised hierarchies

It is always tempting to believe that if we influence policies at the top of local and national governments and at the top of public services and NGOs, then new policies and improved practice will inevitably filter down to the children and families who need early child and family support. There is some logic in the top-down approach because the people at the top can establish policies, have authority over people lower down in the hierarchies and can allocate resources. They are powerful people. There can be three failings in this approach: firstly, policy and practice can be perverted and distorted in the filtering down; secondly, the new work survives for only a short time; thirdly, the new work does not spread out horizontally at the grass-roots to embrace children and families beyond the limited scope of the initial new initiatives or pilot projects. Being aware of the limitations of the top-down approach can encourage us to consider other approaches and, when we use a top-down approach, show us what safeguards we must build into it.

a) How policy and practice can be perverted and distorted in the filtering down

It is unlikely that senior people at the top of our vertical organisations can share the same long-term commitment and passion for improved support for these children and families that we find at the grass-roots. This is inevitable. While they might initially give everything to a new initiative to build or reform early child and family support, they will have other challenges on their desk next morning or next week. The same will be true for managers lower down in the hierarchies.

These lower managers who have the responsibility to pass down the new work will have varying levels of passion, commitment or enthusiasm and will accordingly vary in the amount of time, energy and resources they want to devote to it. The same must be true for the practitioners at the grass-roots who work with children and families. Each will have attitudes about the new policies and practice and views about the benefits or challenges they bring to their present way of working and to their professional ethics. Emotions have their part to play too: effective integrated early child and family support relies on teamwork that relies in turn on a high level of honesty, trust and respect between colleagues. The filtering down process can founder here when practitioners do not yet have the required personal skills for genuine teamwork. Sadly, perversion, distortion and delay in enacting new policies at the grass roots happen even when the new policies come in a legal framework.

b) New work might survive for only a short time

New systems for a city, region or country’s effective integrated early child and family support are likely to be fragile and might eventually succumb to one or more common threats. These include: ministers, managers or practitioners losing their initial enthusiasm and commitment; people having to divert their attention to other issues by force of changing circumstances; initial funding coming to an end and no new sources found – this very often happens to pilot projects; the plight of another group of people coming to the fore and taking precedence over the children and families this essay is discussing ̶ because of ever-changing social conditions and trends.

c) The new work does not spread out horizontally

The only valid intent must be to offer effective integrated early child and family support to all who need it in each city, region or country. There is no logic or fairness in restricting the effort to only a limited number of families. In this case, each new initiative must have two phases: firstly to establish a new system for a first group of children and families; secondly to roll successful work out horizontally across the city, region or country.

This second phase presents very different challenges from the first phase and is often neglected. The first phase can be seen as the easy part and is counted as a success when a number of families are helped. The official reports and press releases will reflect the achievement and the new benefits brought to these families but, at the same time, mask the number of families who have not been helped and might never be. Arithmetically, it might be that of the children and families who need the new work, only 10%, 5%, 1%, 0.1% or 0.01% or fewer have been helped. The second phase is very important indeed but might be neglected because it does not have all the glamour and excitement of the first pioneering projects. In fact, it is only the second phase that justifies the energy, time and money invested in the first.

Many readers who have direct experience of new top-down initiatives in effective integrated early child and family support will be able to add to my list of threats to their sustainability.

* See 'Integration made possible: A practical manual for joint working'.

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In the second part of this essay I will describe Interconnections’ efforts since the 1990s to promote enhanced integrated early support for these children and families. By decision, this was not a top-down approach – but had its own limitations.

Peter Limbrick

April 2021