Coronavirus: New research highlights challenges of moving support for vulnerable children online

New @TheEIFoundation research highlights challenges of moving support for vulnerable children online 

Covid-19 is forcing public services to switch to providing support to children and families remotely, but the evidence on the effectiveness of virtual or digital interventions is mixed, and adapting or introducing remote services must be done carefully to avoid exacerbating the risks facing vulnerable children and families

Research from the Early Intervention Foundation (EIF) on virtual and digital (V&D) interventions that might be used to support vulnerable children during the Covid-19 pandemic, has found there are serious challenges to making them work as effectively as the traditional, face-to-face interventions that were being delivered prior to the lockdown. A review of existing studies found V&D interventions to be less effective or no more effective than traditional approaches, in terms of improving outcomes for children.  

The findings also highlight that many of the challenges facing traditional public services, such as access and keeping up participation, are likely to be more rather than less serious when these services are delivered remotely. 

Examples of remotely delivered interventions include one-to-one and group-based therapy or support provided by phone, messaging or videoconferencing, through to self-guided interventions such as online quizzes, apps and games. The research covers five major areas of support for children, young people and families at risk: mental health and wellbeing, substance misuse, behaviour and violence, risky sexual behaviour, and child maltreatment. 

Tom McBride, Director of Evidence at the Early Intervention Foundation commented:

“Covid-19 is likely to increase both the number of vulnerable children and the severity of the challenges they are facing. It’s important that these children and young people continue to receive effective support and it’s encouraging to see that the sector is rapidly adapting to deliver services remotely. 

“However, achieving this rapid adaptation to remote and digital delivery isn’t going to be straightforward. It’s important not to assume that face-to-face support can simply be moved online and produce the same level of benefits as before. It’s also important that those involved in adapting services can access what is currently known about different virtual delivery methods and the evidence about what has and hasn’t been shown to be effective. What we don’t want to see is the most disadvantaged being left further behind by virtual or digital services that aren’t as widely available or effective as possible.” 

The need to adapt services is already being felt and acted upon. A survey of early intervention providers and developers conducted by EIF alongside the evidence review found 76% (67 of 88 respondents) were continuing to deliver services but with ‘major adaptations’. The eight programmes that have opted to pause delivery for the foreseeable future had little or no existing digital or virtual components. Only 4 in 10 providers (39%) were delivering their programme ‘predominantly through remote methods’ prior to the Covid-19 crisis. 

The report highlights the risk that rapid adaptation may result in the ‘core components’ of an effective intervention being lost. For example, many effective traditional interventions rely on a strong relationship and regular contact between a practitioner and participant. EIF’s research found just 3% of remotely delivered programmes were delivered on a one-to-one basis. Most had no direct practitioner input or contact, with 84% instead involving self-guided or unguided content, such as quizzes, games, videos and apps. The new research highlights that remotely delivered content should be as engaging and personalised as possible, for example, to incorporate the users’ preferences and provide individual feedback. 

Of the 116 existing V&D interventions identified by EIF, only 22% have robust evidence of having been effective. All others were found to have only preliminary evidence of working, no evidence, or evidence of having no effect or a negative impact. While this doesn’t mean that these programmes won’t or can’t deliver benefits for children, it provides a significant note of caution on the effectiveness of existing remotely delivered interventions.   

The evidence relating to existing V&D interventions is not evenly spread across the issues that the report is focused on. 73% of the programmes identified by EIF focus on children’s education or aspects of physical health, leaving just 31 programmes focused on child maltreatment (8 programmes), crime, violence and antisocial behaviour (8), mental health and wellbeing (5), substance misuse (5), and risky sexual behaviour and teen pregnancy (2).  

The evidence also highlights that participant drop-out, a challenge usually, may be worse with V&D programmes. This reduces the likelihood that an intervention will work for those taking part, and undermines the robustness of any evaluation or testing of these interventions.  

The research is clear that V&D delivery can provide some advantages, such as low cost and extended reach, but some important challenges are likely to remain and may become more rather than less difficult to address. 

Jack Martin, lead author of the report and senior research officer at the Early Intervention Foundation said:

“We conducted this research to support the sector during this period of unprecedented change, and to help ensure that vulnerable children and young people – and their families – continue to receive services that are grounded in the evidence.  

“Providers are making a massive effort to keep vital support coming to those who need it most. The study highlights some of the challenges that exist in trying to make this transformation happen quickly, and some of the pitfalls to be avoided. We hope the recommendations in the report provide useful and actionable insights for those who are making important decisions about new and adapted services right across the country.”  

The report contains a number of recommendations for those developing or managing services remotely delivered support for vulnerable children and young people. Despite the identified challenges, the research is clear that V&D interventions can be effective in improving outcomes for young people across a wide range of approaches and issues. 

Recommendations include: 

• Adaptation of existing interventions should include a focus on the core components which must be maintained. Providers should also work with experts in digital delivery to ensure content is appropriate and engaging for the participants it’s aimed at. 
• Those developing and adapting V&D interventions should, where feasible, include frequent contact with a trained practitioner.  
• Services need to consider how to develop strong engagement strategies for their interventions and to monitor engagement so they can detect if interventions are struggling to reach their intended recipients. 
• Given the limited evidence base – especially on the long-term impacts – providers, developers and commissioners should work with the research community to design evaluations which will improve the evidence base on effective approaches to remote delivery of interventions for children and young people.