The future’s bright, the future’s Birmingham

Reliable data about the circumstances of the city’s children combined with a logical response to what those facts and figures say about their health and development and confidence in the potential benefits of evidence-based practice characterize Birmingham’s renewed commitment to prevention.

So argues one of the main architects of England’s second city’s Brighter Futures strategy, Director of Children’s Services Tony Howell. “We start with the outcomes we want to achieve. Then we consider the factors known to influence them – and over which science tells us we can have some control. It’s more than just words for us. We have put in place well thought out methods to turn the vision into a reality.”

He was speaking before the start of a big week for his department when the focus will be on a conference to introduce the Birmingham workforce to the $2.6 billion plan and on visits by prominent US advocates of the kind of coordinated prevention initiatives soon to be trialled.

“In many respects we have started from a position of strength. The educational progress of our students has been good and although advances inside some populations, for example among children in care, has been slower than we would like, reports from national inspections suggest we’ve made some significant improvements during the last few years.”

“It was data that pushed us forward,” he said. "Based on reliable measures administered to a representative sample of all children in the city, our dataset has given us reason to be both optimistic and concerned. Academically, most of our children are doing well. But in common with other English local authorities there are population-wide deficits in behavior and emotions.”

Particularly sobering for the multi-disciplinary planning group that prepared the Brighter Futures strategy has been the finding that conduct disorders among the school population are running at twice the UK national average.

“If we are to put this right, we need a different way of thinking about children and children’s services. The focus on outcomes is very familiar across the service sector. Here we’ve tried to grapple seriously with all the implications of what a genuine concern for children’s development requires.”

At the heart of Birmingham’s plans is a series of initiatives to introduce proven prevention models into mainstream practice. The combination of Incredible Years and Sure Start is one example.

Birmingham has around 70 Children’s Centres – its share of the latest manifestation of the UK’s scientifically unconvincing investment in Sure Start programs. In a new series of experiments the city is integrating their activity with the Incredible Years, so building on work in Wales led by Judy Hutchings which emerged from the Sure Start evaluations with exceptionally promising results. [See Sure Start made more credible by success of Incredible Years [1]]

Several other proven models are being developed, adapted and embedded into routine services for children in the city. So far the list includes Nurse Family Partnership, PATHS and Triple P. Several others, including KEEP, are under close consideration.

The Brighter Futures strategy has several unique features. One is confidence in a population-wide approach – in the argument that progress with all Birmingham’s children will benefit those whose health and development is impaired. Another is the attempt to align practice reform with improving scientific knowledge about children’s development.

As Cheryl Hopkins, the policy maker leading and implementing Brighter Futures explains, Birmingham is one of the first local authorities to take account of the fact that the brain continues to develop into the early twenties: the Brighter Futures remit extends from conception to a young person’s twenty-fifth birthday.

“We have tailored our initiatives to each stage of children’s development.” she says. “There are components for preschoolers, primary school students, young people in secondary school and for those making the transition into adulthood.”

“Instead of trying to do everything at once we’ve set up a couple of experiments at each stage of development: one for the typical child and one for children in need. If the new programs are successful, they’ll be rolled out more widely, and then we’ll see what else can be achieved.”

Birmingham’s ambition has attracted the interest of US prevention scientists. Speakers at this week’s Working Together for Brighter Futures conference [2] include Steve Aos from Washington State Institute for Public Policy and David Hawkins, who directs the University of Washington’s Social Development Research Group.

Steve Aos will report on the potential cost-benefits of the city’s initiatives. Over $80 million has been added to the $2.5 billion budget to kick-start prevention. But the politicians who are being asked to approve the new expenditure are looking for returns: better outcomes for the children – and less dependency on expensive ineffective provision.

David Hawkins’s interest is in the opportunities that can be created by making small adjustments to workforce behavior. The 50,000 people working with children in Birmingham represent a huge public health opportunity. Small changes in behavior might make them better staff – better parents, too.

• The preparation of Brighter Futures and the rigorous implementation and evaluation of its component parts are underpinned by Common Language, a methodology developed in the UK by Dartington Social Research Unit. The Unit is also the publisher of Prevention Action.