Why early in life is not enough: Timing and sustainability in prevention and early intervention

This chapter critically considers some key assumptions underpinning prevention and early intervention. It focuses particularly on the distinction between preventive interventions early in life as opposed to early in the pathway. Key definitional issues are considered, with emphasis placed on the value of a framework that includes universal, selected and indicated prevention. It is argued that early intervention is a class of indicated prevention. To illustrate the distinction between indicated prevention and selective prevention, two landmark studies are considered. The first, the Iowa Orphanage Study of Skeels, illustrates indicated prevention. The second, the High/Scope Perry Preschool Project, illustrates selective prevention. The discussion then turns to consideration of two key questions. The first concerns timing: Which problems require action when, over what timeframe, where and with whom? The second is the sustainability question: How are gains maintained? In exploring the timing question the focus is on the developmental ordering of problems and the precursors of problems that are evident in measures of temperament and personality, across infancy, early childhood, childhood and adolescence. Recent evidence from the field of adolescent development is introduced focusing particularly on the relationship between neurological change and the emergence of risk-taking behaviours. To address the sustainability question, life-span developmental concepts and longitudinal approaches underpin the argument. Families, childcare provisions, preschools, schools, peer groups, vocational, further and higher education, community organisations, and the world of work, are seen as key sustaining social systems vital both as the loci for prevention and intervention as well as for maintaining their benefits. The chapter concludes that a life-course, comprehensive approach focused on these key sustaining systems, and supported by integrated policy and practice, is needed to address the key issues of timing and sustainability, as well as the reasons why early in life is not enough.