When prevention is knowing better what not to do

Can it still be such a good idea to take a group of policy makers, managers and practitioners from the UK to the US to learn about evidence based programs? All that carbon to offset in the name of better outcomes for children!

I’ve been a strong advocate of this kind of exchange. I've been making regular commuting trips across the Atlantic for the last ten years, worrying increasingly about the wider environmental implications. But most of what I’ve learned about prevention in that time I attribute to having been able to see familiar problems being dealt with in unfamiliar cultural settings.

Just like any other kind of tourism, study tourism can create hugely mistaken impressions nevertheless, and in the case of the traffic between the UK and the US there is the special language problem to consider. We would regard America so differently and so much more clearly if the official US tongue was other than English. George Bernard Shaw was right: it’s the “common language” that divides us.

The group I traveled with to Washington, last week, managed to steer clear of the stereotypes. As much as they wanted to learn about the programs on view and to be able to speak to the people who developed them, they were eager to understand how US society works.

Why are communities so worried about young people drinking alcohol? How does a court probation officer work alongside specialists in Functional Family Therapy or Multisystemic Therapy? Who pays for what, and how? In other words, for the inquisitive study tourist, finding out what goes on around a program is as important as the prevention or early intervention energy it directs and contains.

That said, many travelers had repeatedly to remind themselves of the big structural differences between Europe and the US: the absence of universal health care, the size of the prison population, the requirement that each State should balance its budget. The implications take time to percolate the European mind – and they are fundamental to our conception of prevention.

For my part, not only do I continue to learn from these visits, I’ve also come to depend on them. In the course of the week I jotted down 21 ingredients essential to the successful translation of evidence-based programs to mainstream systems. Some that I had already registered I now understand better. Several were entirely new to me.

My abiding impression is of how hard prevention and early intervention must struggle to rise above the the status of an “add-on”. Even on their native soil, too many phenomenal programs languish on the edge of mainstream systems, insecurely supported by community interests or inconsistent funding. 

So we learned as much about what we should not do. Sidelining prevention to the margins of society is a developmental step that Europeans may stand a better chance of avoiding if the messages we are bringing home are allowed to get around.

It was also striking how much we learned from one other, sharing buses, conference rooms and breakfast and dinner tables. At such close quarters, the practitioner can’t help but get to know how the managers of children’s services think, and they in turn tune into the preoccupations of politicians and businessmen.

And, on this particular tour, a series of encounters with representatives of the Annie E. Casey Foundation who want to introduce more prevention science into their system reform methods created another cycle of illuminating dialogue.

One way to measure the success of a study tour is to assess how eagerly the next one is being anticipated.

On that score, perhaps it’s time to bring US prevention experts to Europe to see how systems can be transformed. From Scandinavia, for example, there is news of fast progress toward integrating evidence based programs into mainstream children’s services. So maybe we should go east, next time.