This message is longer than usual. 2009 was a turning point for WAVE and I thought it appropriate to reflect on what we have achieved over the last few years before writing of the new 70/30 strategy - to reduce childhood maltreatment by 70% by 2030 - formulated in 2009.
Introduction and Reflection on 2005-2009
2009 marked a time of major change for WAVE. To understand why, it is relevant to reflect on the successes of the previous few years and on one major area of work where as yet no visible progress has been made.
The years 1996-early 2009 may be seen as an unbroken line in WAVE's mission to make the world a safer place for both adults and children. For the first 9 years we were immersed in research into the roots of violent behaviour, culminating in the publication of our report in late 2005, Violence and what to do about it, which summarised the findings from this research.
Late 2005 to early 2009 produced greater success than we might have expected in acceptance by major political parties and government departments of the strategic principles of early intervention proposed in our 2005 report. This success has been captured in commendations on our work by such people as then Cabinet Minister the Rt Hon Hilary Armstrong MP when she said 'The work of the WAVE Trust is extremely important as we look to prevent problems before they escalate. The excellent research the trust has undertaken... shows clearly how early neglect and abuse can lead to problems in later life. This work is crucial in helping us improve life chances and [tackle] violent and antisocial behaviour.' Labour MP Graham Allen, the most tireless campaigner in parliament on behalf of early intervention, said 'WAVE's work with the Cabinet Office and the Treasury was invaluable in helping change Government attitude to the importance of early intervention in an overall violence reduction strategy. Their strategy of collaborative engagement with Ministers, MPs, Government departments, Police, Health, and Education services, Local Authorities and others has saved years in our journey towards a violence-free society' while former Conservative Party leader the Rt Hon Iain Duncan Smith MP said 'WAVE Trust is a small charity with the impact of a big one. I recently had cause to be present when they made a detailed presentation on early intervention and cannot recall seeing a more impressive and convincing presentation of the facts. What I learned from WAVE that day, informed and greatly influenced the Centre for Social Justice's approach to policy on children and families, as published in our report Breakthrough Britain'.
There are many similar accolades for our work in the period 2005-2009, which can be read on our web site, from MPs; senior police officers such as former Metropolitan Police Commissioner Sir Ian Blair and Commanders at New Scotland Yard and elsewhere; Local Authority CEOs, Directors of Children's Services and other senior officials; leading researchers from institutions such as Oxford University and the Dartington Social Research Unit; the World Health Organisation, and others.
Just as encouraging have been the words of thanks from individual victims of violence (I found a new strength through reading the WAVE report and I would promote it as my way forward. I feel confident again. Like all my nagging questions are being answered), or violent offenders who have become reformed through our therapeutic work in prisons (e.g. 'Before I completed WAVE's An End to Violence Therapeutic Programme I was angry with the world; meaning society, my community and my life. This anger caused me not to think about life or anything in a positive way, therefore I led a life down a path of destruction. One year on from completing the programme I am at peace with myself and all that the world, society and life can throw at me. I am now in a content place in my life where I am able to see life in its real reality and I am able to deal with it in a rational way without even a thought of violence.') This particular violent offender is still leading a peaceable life four years later and contributing to help young offenders turn away from lives of violence.
We have also seen our recommendations adopted "on the ground". The prime recommendation in our 2005 report, and one we had been pressing on government since 2001, was for the UK to run pilot studies of the intensive home visiting programme Nurse Family Partnership. In part as a result of our presentations to the Cabinet Social Exclusion Unit, and our bringing the programme originator Dr David Olds over to Britain to meet senior policy makers, this programme has been piloted in the UK and rolled out to over 40 pilot sites around the UK, under the name the Family Nurse Partnership. Initial evaluations have been very positive. In addition there was progress with our second recommendation, for the introduction into the UK of the school-based parenting programme Roots of Empathy, which teaches small children how to interact in a nurturing manner with babies, by bringing a real baby and its loving parents into the classroom. In 2008 this began to be rolled out to every primary classroom in the Isle of Man as a direct result of our work on that island, and we will report below further progress in 2009.
Finally there has been the partial adoption of the recommendation in our 2005 report that one city in the UK should be designated an Early Intervention City, and should then pilot a suite of WAVE-recommended research-proven early interventions to see if there is a cumulative effect from adopting a cluster of programmes known to be individually effective elsewhere. Nottingham has indeed been designated as Early Intervention City, as a result of a presentation we made to then Home Secretary John Reid, but despite the tireless efforts of Graham Allen, the local MP, who set up our meeting with the Home Secretary, the programme has not been implemented as we recommended. Instead of the suite of research proven programmes we proposed, local considerations including financial constraints have meant that the city has introduced a mix of locally developed initiatives, programmes which may be good but are not research-underpinned, and currently just two of our recommended programmes: Incredible Years and Family Nurse Partnership. We wish Nottingham well, but it is not - yet at least - the pilot we recommended. Graham Allen is working hard to have Roots of Empathy introduced in Nottingham in 2010.
70/30 Business Plan
Gap between conviction and implementation
There have been numerous other successes, but the reality we addressed at the beginning of 2009 was that levels of child maltreatment in the UK did not appear to be reducing. While adoption of our ideas has been very successful at the strategic level, take-up is still minimal at the level where new policies need to be implemented - local authorities and primary care trusts.
The reasons are understandable: basically, the available funding is scarcely enough to cover essential reactive work let alone to allow adequate investment in prevention. Moreover, UK systems are almost universally designed to react to abuse and neglect, rather than to prevent them in the first place. However, recent research indicates that primary prevention (i.e. before abuse or neglect take place) is operationally and financially more cost-effective than responding after the initial damage has been done. We need to react effectively while we develop proactive, preventive systems. That will mean investing new money in primary prevention rather than seeking to compete for the already stretched funding for treating the symptoms.
70/30 commitment: the background
Moreover the scale of the problem is huge. In 2000 an NSPCC report (Cawson, P., Wattam, C., Brooker, S. and Kelly, G. (2000) Child maltreatment in the United Kingdom: a study of the prevalence of child abuse and neglect. London: NSPCC) estimated levels of child physical abuse in this country as being:
0.8 million children (7%) every year who suffer regular serious abuse, where there had been violent treatment regularly over the years, or violence which caused physical injury, or frequently led to physical effects lasting at least until next day.
1.7 million (14%) per annum who suffered irregular violent treatment, and with less frequent lasting physical effects, or where other physical treatment/ discipline such as slaps, smacks and pinches occurred regularly and caused injury or regularly had lasting physical effects.
Beyond these estimated 2.5 million children who were being particularly harshly treated, there were a further 0.4 million (3%) where the NSPCC expressed 'cause for concern' because either less serious - but still inappropriate - physical treatment/discipline occurred regularly, or there was irregular physical discipline which often had lasting effects.
Occasional slaps, smacks or pinches which rarely or never had lasting effect were excluded from the assessment of abuse.
We have studied police reports from both London and Strathclyde, and could find no evidence that levels of abuse have decreased since 2000. Indeed the NSPCC in 1995 stated that levels of abuse in Britain had not fallen since the Second World War.
The NSPCC will update their 2000 report in 2010, and hopefully a more accurate assessment of the scale of the problem will be provided, but it seems clear that the problem remains huge.
Turning to neglect, the researchers estimated that:
0.7 million children (6%) suffered serious absence of care, meaning children frequently going hungry, frequently having to go to school in dirty clothes, not being taken to the doctor when ill, regularly having to look after themselves because parents went away or had problems such as with drugs or alcohol, being abandoned or deserted, or living in a home with dangerous physical conditions.
1.1 million (9%) suffered intermediate absence of care, where the above conditions applied but with less frequency, with an additional category of children under 12 that always or often had to do their own laundry.
A further 0.2 million (2%), described as a 'cause for concern' group, were those who said that their home was unclean, they sometimes had no clean clothes for school, and they rarely or never had dental check-ups.
A further category of neglect was absence of supervision. Here the researchers found a disturbing 37% of children - nearly 4 and a half million - were a cause for concern. Specifically they estimated that:
5% of children (0.6 million) suffered serious absence of supervision included children allowed to stay at home overnight without adult supervision under the age of 10, or allowed out overnight without parents knowing their whereabouts, aged under 14.
12% of children (1.4 million) suffered intermediate absence of supervision, including those left unsupervised overnight aged 10 -11; allowed out overnight, whereabouts unknown, at age of 14 - 15, and under 12s frequently left in charge of younger siblings while parents were out.
3% (0.4 million) were 'cause for concern', being those left without adult supervision in the evening, or going to the town centre shops without an adult or much older child, when they were under 10 years old.
Beyond all these was a further 17% (2 million) 'other absence of supervision' who were left unsupervised in the evenings or went unsupervised to town centre shops at age 10 or 11, and under 12s sometimes left in charge of younger siblings while parents were out.
In addition to the above, a 2003 Department of Health report (Department of Health, Women's Mental Health: Into the Mainstream, 2003) estimated that 'at least' 0.75 million children per annum witnessed domestic violence each year.
On the basis of these numbers is seems conservative to estimate that at least 2 million children per annum suffer significant levels of child maltreatment.
70/30 commitment: the consequences of inaction
Nor are the consequences of such maltreatment minor in their effect.
A study in the United States, of middle class Americans (Felitti V.J., Anda R.F., The Relationship of Adverse Childhood Experiences to Adult Health, Well-being, Social Function, and Healthcare. Chapter in Lanius R, Vermetten E., The Hidden Epidemic: The Impact of Early Life Trauma on Health and Disease. Cambridge University Press, 2009), found strong correlations between children who suffered Adverse Childhood Experiences (ACEs) such as abuse, neglect, witnessing domestic violence and parental separation and the leading causes of morbidity, mortality, and disability in the United States: cardiovascular disease, chronic lung disease, chronic liver disease, attempted suicide, depression and other forms of mental illness, obesity, smoking, and alcohol and drug abuse. For example the researchers found that a child with an ACE score of 6 (i.e. suffered 6 categories of ACE) had a 4,600% higher likelihood of becoming an intravenous drug user than a child with an ACE score of 0. This work challenges traditional views of addictions as being substance-dependent and suggests instead that they are more 'childhood experience-dependent'.
Felitti and Anda found 17% of their middle-class population had suffered four or more categories of adverse childhood experience.
In addition Felitti found ACEs correlated with absenteeism from work, problems when in employment and sexual promiscuity. Other studies uncovered in WAVE's research programme have shown early child maltreatment contributes to poor educational attainment, reduced career prospects, lack of wealth generation, antisocial behaviour and violence. These are blights with massive cost consequences for society, and they are to a significant extent preventable.
70/30 commitment: the strategy
Against the background of decades of ineffectual action to reduce child maltreatment, we feel that the more than 2 million children in the UK who annually suffer severe abuse or neglect deserve more effective action than the current approaches that merely tinker around the edges. We have therefore created a business strategy whose aim over the coming decades is to create a radical reduction in levels of both violence and child maltreatment, with the initial focus on the latter because this seeds so much violence. (Here, our definition of maltreatment includes physical abuse, neglect and witnessing domestic violence.)
Our proposed approach has been to set a radical but achievable goal of a 70% reduction in child maltreatment by the year 2030 - we call this the '70/30' objective - and to create a coalition of supporters, spanning political parties, charities, professional experts and grass roots, with the intention of creating an unstoppable momentum supporting and arguing the case for change. We recognise that there will be resistance, not least the argument that society cannot afford the costs of such an initiative. Our counter-argument is that society cannot afford not to make the necessary change. The economic case for the types of effective interventions we have identified is potentially overwhelming, and we recognise our responsibility to make that case. This will be an important priority in 2010.
An important part of our work in early 2009 was to develop a robust but realistic Business Plan for the period 2009-2014 which sets out an overall strategy and detailed milestones for the next few years to be on track to deliver 70/30. This Business Plan has five main elements:
Building political consensus;
Prevention and early years' intervention policies being widely implemented by local authorities and primary care trusts;
Major sections of the media supporting 70/30;
Detailed policy development proposals prepared showing how 70/30 can be achieved in practice;
WAVE financially robust and fully resourced to achieve our aims.
The business plan also sets out 30 detailed annual milestones to be achieved in support of these goals and outlines how they will be achieved.
A further development of the Business Plan is the preparation of a draft Communications and Media Strategy. This was prepared in late 2009 with the help of pro bono support from the Marketing Department of Diageo.
Reactions to 70/30
At the time of writing this report in February 2010, the coalition in support of 70/30 has been joined by 4Children, Action for Children, the Association for Infant Mental Health, the Centre for Social Justice, the Children's Society, Kids Company, Parenting UK, the Smith Institute, Time for Families, 'What About the Children?' and the Young Foundation. The Vice-Chair of the British Association for the Study and Prevention of Child Abuse and Neglect expressed strong support and invited WAVE to present the case for 70/30 to their tri-annual conference in Swansea in September 2009. Vivette Glover, Professor of Perinatal Psychobiology at Imperial College, was so enthusiastic she joined WAVE as a Trustee. Professor Kevin Browne of Nottingham University (a leading researcher on child abuse) joined the 70/30 commitment and offered to work in partnership with WAVE to create this shift. David Stone, Professor of Paediatric Epidemiology, at Glasgow University and John McLaren, an economist at Glasgow University who has worked on the economics of early prevention and intervention with the Nobel Prize winning economist James Heckman also volunteered their support.
The Rt Hon Iain Duncan Smith, former leader of the Conservative Party, and cross-party peer General the Lord Ramsbotham GCB CBE both agreed to join Baroness Walmsley, Liberal Democrat spokesperson for Children in the House of Lords) as Patrons of WAVE, to express their backing for 70/30. (A balanced cross-party support will be maintained by the addition of a prominent Labour Patron in 2010; discussions are ongoing.)
A major activity in 2009 has been time invested in creating a coalition of major funders who back 70/30. Not all funding applications were successful, but a strong coalition has been created. Initial members include the Joseph Rowntree Charitable Trust, the Man Group Charitable Trust and the Esmee Fairbairn Foundation. Further details are given below in the Fundraising section of this report.
Research and educational work
An important part of WAVE's work is keeping in touch with ongoing research into violence, its root causes, and global best solutions. We also look widely at related research, such as the wider consequences of child maltreatment or domestic violence. We refer above to the work of Dr Vincent Felitti in California. Part of our work in the past year has been spreading awareness of this work, which reinforces the likely financial pay-off to society from giving priority to protecting children from maltreatment.
During 2009 WAVE presentations were made to professionals and policy makers in Belfast (two), Croydon, Edinburgh (two), Greenwich, Islington (two), Knowsley (Liverpool), Holloway, Londonderry, Nottingham, Perth, Southwark, Swansea and Westminster (several). Feedback continues to be very appreciative with the word 'inspiring' recurringly used by practitioners whom our work seems to galvanise into action in the field of early intervention.
Building political consensus / contributing to policy development
During 2009, with an election pending in the following year, we followed our work with government in previous years with a concentration on input into the Conservative and Liberal Democrat parties. This took the form of informal meetings, formal presentations and written commentaries to members of the Shadow Cabinets.
High Down Prison: An end to violence programme
During the year three members of the WAVE team delivered a group version of WAVE's prison therapeutic programme to 12 violent offenders, aged on average 21 years, in High Down prison in Surrey. This project was funded by the Safer London Foundation. This was an experimental project, moving away for the first time from the previous one-to-one format which has achieved quite remarkable results (no one re-offending with a violent offence in over 10 years). Much was learned from it. During the experiment the group format was dropped mid-way through the course which finished on a one-to-one basis. Much good work had been done, and all the participants were less likely to engage in violence than if they had not taken part in the course, but the overall impact was likely to be well below previous results from a pure one-to-one approach. Most of the participants have now been released and post-release support is being provided. None had been reported as re-offending some 6 months after release. We also understand that none of the small group of teenage offenders we worked with in Croydon in 2008 have yet re-offended.
Roots of Empathy
During 2009 WAVE's work in Northern Ireland led to a decision by one of their area health authorities to introduce Roots of Empathy 'on a large scale' in Northern Ireland, from autumn 2010. This was a direct result of George Hosking's presentations and meetings in Northern Ireland, and subsequent work with the health authorities in the province.
This is another major success for WAVE in getting proven early intervention initiatives in place in the UK.
Family Nurse Partnership
During 2009 the second year evaluation was completed of the Family Nurse Partnership, the intensive home-visiting programme, targeted at 'at risk' families. While some implementation problems are being encountered in some areas - especially the NHS making unplanned time demands on the time of staff for non-FNP activities, or requiring duplicate documentation to be kept - the overall evaluation remains positive. Families gave their nurses an average 9 out of 10 rating for the quality of support they experienced. There are now 50 pilot studies running in the UK, benefiting some 5,000 families. Under its American name, Nurse Family Partnership, this has been one of four top programmes recommended by WAVE for implementation.
Local authority support
WAVE's 2008 work in Tower Hamlets has resulted in the first pilot study in the country to marry the 'whole family' and 'early prevention' approaches.
WAVE also submitted a detailed report and recommendations on risk analysis systems and early interventions to the five London boroughs (the '5 Boroughs Alliance') of Croydon, Lambeth, Greenwich, Lewisham and Southwark. Feedback from local authority officers suggests this has had some impact on local policy priorities.
Particular interest was shown in WAVE's research and recommendations by the Chief Executive of Croydon's Council, Jon Rouse. At end January three members of our team met with senior officers of the Council and made a presentation of our work and local authority policy recommendations. As will be reported in 2010, this work fed in a significant way into Croydon Council's subsequent 'Total Place' project, causing its entire focus to be on early intervention.
Not everything ran smoothly during the year. We had hoped to carry out a long overdue update on our volunteer-created web site, but other work pressures on our small team meant this was deferred until 2010. We are hoping to get some funding to allow this to be completed with paid resource rather than being reliant entirely on volunteers who are already very busy with other priorities in their lives.
We also began a programme of work to carry our message to, and through, grass roots supporters throughout the country. This project also stalled when we lost the volunteer who had begun to co-ordinate this project.
We conducted a fascinating project to measure the shape and levels of anger in Croydon schools, but an administrative error led to this failing to capture data by gender and location, rendering the results difficult to interpret. We then lost the volunteer co-ordinator of the project as she moved to a University in another part of the country. We were struck by the high levels of teen anger revealed in the incomplete results.
We generally had poor results during the year from use of volunteers, too often investing time in training people to the point where they could make a positive contribution, and then losing them to paid work or job hunting. We would benefit from raising funds to employ a paid volunteer co-ordinator with prior experience in managing volunteers.
During the year we input research to several TV documentary makers who approached us for support; George Hosking chaired a discussion at Channel 4's Street Weapons Commission Forum; we had a number of meetings with the London Mayor's office, at which we input proposals on early intervention; and we had discussions with some 50 organisations concerned with policy formation and/or violence reduction, from the Cabinet Office and Centre for Social Justice through Feltham Young Offenders' Institute and the London Serious Youth Violence Board to the UK Public Health Association.
WAVE's work in 2009 has been strongly and crucially sustained by core funding from the Joseph Rowntree Charitable Trust. It would be true to say many of the achievements above have only been possible because of this support from Joseph Rowntree. In addition we have received valuable support from the City Bridge Trust towards rent costs, and received welcome windfall donations from Emily Crompton and Christian Candy, who ran the Barcelona Marathon on WAVE's behalf, and the girls of the 6th Form (2008-2009) in Croydon High School for Girls, who ran a superb fashion show from which they donated the whole of the takings to WAVE. WAVE has also benefitted from donations from a number of individuals some of whom have sustained that support over a number of years.
During the year Joseph Rowntree described the work being conducted by WAVE as 'stunning'.
We would also like to acknowledge the support for our important project work from Cameron Consultants, Erach and Roshan Sadri Foundation, the Home Office Community Fund, Man Group plc Charitable Trust, the Metropolitan Police, Safer London Foundation the Tom ap Rhys Pryce Memorial Trust.
At end 2009 £654,000 of 'future' funding had been raised to support 70/30, from Esmee Fairbairn Foundation and Man Group plc Charitable Trust, both of whom have shown great faith both in us and in 70/30. We are most appreciative of the far-sightedness of these two strategic funders, and their willingness to invest in the future of children in Britain. In addition we have forward funding from organisations such as the Home Office and Trusthouse for future projects in the fields of crime reduction and treatment of victims of post-traumatic stress disorder, in prison or post-release.