Over the past 10 years early intervention has been a major theme in government social welfare policy. The common aim is that, by intervening early, care services can prevent difficulties in individuals’ and families’ lives deteriorating to the extent that acute or specialist services need to become involved, often at a point of crisis. As such, policymakers have argued that there is a moral and economic case for such an approach. The projects and services which feature in this year’s Community Care Excellence Network show how this policy can work well.
What is striking from the range of projects presented is their diversity and the commitment and creativity. They are responding to different challenges and therefore vary greatly.
However, it is clear that there are some common features that illustrate and support the growing body of evidence that has emerged over the past 20 years on the effectiveness of early interventions and preventive work. One challenge facing preventive services is how to reach those who may need the support. Each, however, has managed to address difficulties of access and this has been helpful in de-stigmatising those services. Each has recognised that there is a continuum of need and that services need to identify and meet users’ changing needs rather then wait until they reach eligibility criteria set at crisis levels.
There is also a strong multidisciplinary character to each project. A range of professionals is involved and a number of new professional roles are increasingly characterising the social care sector. The presence of new professionals should not, however, detract from the contribution made by the more established professionals. Readers of this magazine will be interested in the role social work can play. And many service users testify to the positive influence of social workers. Indeed, the paper on the roles and tasks of social work by the General Social Care Council reinforces this.
The success of these projects is all the more impressive because designing and delivering preventive services built on the basis of early intervention can be complicated. The central problem is that it is not always possible to identify who may need the long-term support. By their very nature, early intervention projects addressing lower levels of need are not going to be as targeted as the more specialist services. At a time when resources are limited and demand is growing, the preventive agenda raises the questions of how to strike the balance between allocating those resources to those in the most need and allocating to those with less serious problems but whose difficulties may deteriorate in the future.
Early intervention can also raise ethical dilemmas. Although it is considered benign and positive for services to offer as much support as early as possible, state intervention in particular can be considered intrusive and professional involvement punitive if service users do not feel they are able to have control and make informed choices about the nature and extent of this support. Again, the projects featured here are to be commended for avoiding such pitfalls.
Commitment and passion
Although there is an emerging consensus regarding the effectiveness of early intervention it is not an easy area to research. Methodologically researching areas such as family support can be highly complex and establishing the link between a particular configuration of services and ways of working with improved outcomes for users of services can be challenging. Therefore, there remains a need for government and other bodies to continue and indeed increase funding in this area of research.
These Excellence Network projects show why early intervention and prevention deserve support from policymakers that matches the commitment and passion shown by many of the practitioners who work within them.
See the honoured teams in the early intervention category
James Blewett is research director of Making Research Count, Social Care Workforce Research Unit, King’s College London