• Complexity of successful service delivery. “Interventions that work are rarely simple, inexpensive, or easy to implement.”

Given the diversity of interventions that have been proposed and implemented, Dr. Shonkoff indicated that his remarks would focus on early childhood intervention as a prototype—to serve “as a heuristic model for thinking more broadly about how we might approach behavioral and social interventions across different ages and venues.” Early childhood intervention, he said, is a useful model because it rests on a sound theoretical framework, builds on a strong experimental base, and provides promising foundations for a life-span strategy because of its prevention orientation.

Effective interventions in the early childhood years have a number of distinguishing features, Dr. Shonkoff said. The first is the importance of an individualized approach linked to specific objectives. In contrast, programs that are built on a one-size-fits-all model and guided by broad generic goals are relatively ineffective.

A second feature of successful programs is the high quality of their implementation. Central to this success is a well-designed intervention strategy, appropriate staff training, and careful monitoring of service delivery over time.

A third feature of effective interventions in the early childhood period is the quality of the relationships that are built between the people who provide the service and those who receive it. The positive “effects of relationships on relationships” may be at the heart of what makes early childhood interventions work, Dr. Shonkoff said. “That is to say, the provider-parent relationship influences the parent-child relationship, which, in turn, can result in positive outcomes for both the child and the parents.”

A fourth feature—that early childhood intervention be family centered, community based, and coordinated—“is embedded in a strong theoretical framework,” Dr. Shonkoff said, “but has not been sufficiently validated empirically.” For example, the widespread belief that programs are more effective when delivered through parents rather than focused directly on children may or may not be true in all circumstances, as we do not have sufficient experimental data on this dimension of service delivery. This “is an important issue because high levels of parent involvement in early childhood programs are more difficult to achieve than they were when fewer mothers were in the workforce.”

The last feature of effective interventions relates to the critical dimensions of program timing, intensity, and duration. Here again, “the field is



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