Questions/Answers

From 2011 to 2014 a model for early childhood intervention (Frühe Hilfen) in Austria was developed by Gesundheit Österreich (GÖG). This is based on international evidence as well as a systematic analysis of practical experience. The main objective is to support families under strain (e.g. from poverty) during pregnancy and the first three life years of a child's life. The support services concerned promote healthy early childhood development, as well as equal social and health opportunities. The roll-out of regional early childhood intervention networks began in 2015, and these are now in place in all the country's provinces. In 2015 the Federal Ministry for Health tasked Gesundheit Österreich (GÖG; Austrian Public Health Institute) with establishing the Austrian National Centre for Early Childhood Interventions. The centre‘s mission is nationwide coordination and harmonization (inc. documentation and monitoring), quality assurance (i.e. training, evaluation and research), and knowledge transfers, as well as process guidance and advice on the establishment of regional networks. By the end of 2017 coverage by the networks extended to more than half of all the administrative districts in Austria. All the networks record data about the families supported in a unique data collection system (FRÜDOK) hosted and analysed by the Austrian National Centre for Early Childhood Interventions. The data reveal a rapid increase in the number of families supported by the regional networks. The networks reach the target groups - socially disadvantaged families, esp. those at risk of poverty, migrants and single parents - at any early stage. A recent evaluation shows clear benefits in terms of social inclusion, self-esteem, parental skills and reduced stress, economic hardship, etc. for the families supported. It also highlights the importance of the role played by the National Centre with regard to coordination and quality assurance.

There is clear evidence that the development of cognitive, social and emotional skills in early childhood, as well as the long-term health and life perspectives, are strongly influenced by social determinants. It is therefore necessary to address these factors during early childhood – in particular, by reducing social inequities as well as helping families to look after their children well. The main objective of the Austrian model for early childhood intervention is hence to support families under pressure (e.g. from poverty, mental strain or isolation) during pregnancy and the first three years of a child's life. It aims to promote healthy early childhood development, as well as equal social and health opportunities. The goals of the programme are pursued by setting up regional networks that reach out to families at risk and help them to access a wide range of relevant services. The Austrian National Centre for Early Childhood Interventions was set up to drive regional implementation. It seeks to provide nationwide coordination and harmonization (inc. documentation and monitoring), quality assurance (i.e. training, evaluation, research) and knowledge transfers, as well as process guidance and advice on the establishment of regional networks.

The Austrian approach to early childhood intervention is built on a broad partnership of stakeholders in politics, public administration and civil society. The regional networks provide inclusive access to a variety of relevant social and health services in their areas. Monitoring and evaluation show that the programme is succeeding in addressing the needs of disadvantaged and vulnerable families. At least 50% off the families supported in 2016 were poor or at risk of poverty (compared to 14% of the overall population), while 36% of primary carers were born abroad (versus 24% of the population at large) and 23% were single parents (versus 14 % of the population). The evaluation shows that the families supported clearly benefit from the programme. The early childhood intervention networks increase families' psychological resources (i.e. social inclusion, self-esteem, positive family climate, parental skills, health literacy) and reduce the burdens on them (i.e. stress, anxiety, economic hardship, mental strain and social marginalisation). Thanks in large part to these improvements in families' situations, the programme has a positive impact on child-parent bonding and interaction.

The Austrian programme for early childhood interventions supports healthy early childhood development as well as social and health equity. All of these are key issues in connection with the SDGs. As former UN Secretary-General Ban Ki-moon stated, “The SDGs recognize that early childhood development can help drive the transformation we hope to achieve over the next 15 years.” In general, the initiative supports human dignity and equality, reduction of poverty and inclusive societies. More specifically, it contributes to the implementation of the following SDGs: Goal 4: Ensure inclusive and equitable quality education and promote lifelong learning opportunities for all; in particular, target 4.2 (access to quality early childhood development, care and pre-primary education); Goal 3: Ensure healthy lives and promote well-being for all at all ages; especially target 3.4 (prevention and treatment of NCDs; promotion of mental health and well-being); Goal 1: End poverty in all its forms everywhere; especially target 1.2 (reduction of poverty)

Prior to the programme launch an assessment of the status quo on early childhood interventions in Austria was carried out. The results showed several significant shortcomings of service delivery to pregnant women and children up to three years old in need: Most of the service providers reported that they were unable to reach out to the target groups due to organisational barriers. There was a significant lack of co-operation and networking between different service providers, and this made it difficult to meet the complex needs of the most vulnerable, who required support through a mix of services. Overall, this meant that there was little success in reaching and effectively supporting relevant the target groups. The initiative addresses these shortcomings by proactively providing low threshold access to the target groups as well as investing in co-operation and networking between the different service providers. Thus, it allows to systematically address troubled families and to comprehensively support them in a way that meets their complex needs.

The design of the programme (see 4.) enabled it to achieve a particularly high take-up rate among poor and vulnerable population groups (see evaluation results). As recent monitoring and evaluation results show, families at risk (poverty, mental strain, social marginalisation, single parent, children with special needs, etc.) are helped to improve their living conditions, cope with difficulties, access resources, and promote the early development of their children (see also evaluation results). Families are invited to give anonymous feedback on the programme to the National Centre (using a feedback form). The vast majority report high satisfaction levels (almost 100%), find the programme very helpful (almost 100%), feel empowered by it, and would recommend it to other families (95%). To take an example, a beneficiary stated: "Since I was feeling very bad at the time I was very glad to have somebody who understood my situation and gave me the feeling that I was not alone with my problems. Everything perfect. Thanks a lot. It was very helpful for me."

The design of the programme was based on a needs assessment. Its aim was to overcome existing shortcomings in service delivery, taking into account scientific evidence as well as practical experience. No comparable, nationwide offering existed prior to the programme. In order to effectively support early childhood development as an important driver for social and health equity and the SDGs in general, the programme applies the following innovative approaches: » To reach families actively and systematically by raising awareness among those in a position to identify and refer families in need; » To provide continuous and comprehensive family support (mostly as home visits) throughout a longer time span; to build up mutual trust; to provide a model for bonding; to refer clients to specific services offered by the regional network; » To underpin general and case-related cooperation and networking (network management to assist in the establishment and maintenance of regional networks) and a multidisciplinary support system offering a wide range of well coordinated services for parents and children.

The initiative is original in that it developed a national model which reflects the Austrian setting (strong federal tradition, preexisting range and character of the service landscape, etc.). As explained above, the model is based on research findings, as well as practical experience acquired in various countries (mostly German speaking, Anglo-Saxon and Scandinavian), as well as the Austrian regions (esp. Vorarlberg). The scheme did not simply adopt a preexisting model but created a new one. The Nationales Zentrum Frühe Hilfen (National Centre for Early Childhood Interventions) was derived from a German model but was adapted to the local range of tasks, activities and partners. Due to the fact that Austria is a smaller country - in comparison with Germany - and early childhood intervention is more widespread, the National Centre is in closer contact with regional stakeholders. It provides direct support (i.e. training, networking meetings, documentation and advice) to the regional networks.

Between 2015 and first half of 2017 about €5 million (m) were spent on implementing the programme. At least €15m are budgeted for the 2017-2021 period. In all nine Austrian provinces there are regional co-ordinators to supervise implementation. There are now 25 regional networks, about 120 family counsellors and some 40 network managers at work. In addition, many stakeholders and service providers are involved in implementation at regional and national level. The National Centre has about €500,000 per year in funding, which also covers the cost of documentation, training, evaluation and research, etc. It has about ten staff. The centre is in contact with all the regional networks, co-ordinators, family counsellors and network managers. In addition, there are several programme committees with a broad based membership representative of the main public and civil society stakeholders involved.

Yes

Firstly, the model has been transferred to various regions within Austria. It is open to adaptation to local requirements. Leading figures in the national public health community are interested in learning from the experience of the programme (esp. regarding aspects of current Austrian health reform such as integrated social care and primary health care, and the linking of health promotion and health care). In addition, the National Centre is in close touch with partners in other German-speaking countries and regions. There is interest in the Austrian model, esp. from colleagues in Switzerland and South Tyrol/Alto Adige. In 2019 a joint conference of German-speaking countries/regions (Austria, Germany, Switzerland, Liechtenstein and South Tyrol) will be held in Austria to exchange information. Information exchanges also take place with many other European countries (e.g. at conferences). Some countries from Central and Eastern, and Southeastern Europe have expressed a strong interest in learning from the Austrian programme.

The evaluation findigs show that the programme has improved the assisted families' situation in many different ways: relief of economic pressures (i.e. debt relief, improved access to welfare benefits), improved social inclusion and mental health, and better housing and job opportunities, as well as improved access to social, health and educational services in general. In order to estimate the lasting impact a prospective cost-benefit analysis was carried out in 2017 by the National Centre. This showed a high long-term return on investment of between 1:16 and 1:25, mostly due to improved education and training, increased labour market participation and higher added value. Moreover, there is a positive return on investment for each sector concerned (child welfare, health, education, etc.). The results are in line with international findings.

The initiative started back in 2009, as an offshoot of the Austrian child and youth health dialogue. A research project carried out between 2011 and 2014 assessed the status quo and needs in Austria, as well as domestic and international evidence and experience. In 2015 regional early childhood intervention networks began being rolled out across all the Austrian provinces, with support from the Nationales Zentrum Frühe Hilfen (Austrian National Centre for Early Childhood Interventions). Funding for the existing networks as well as the National Centre is already in place up to the end of 2021. Efforts to establish a financing model that will be sustainable in the long term are currently being made in connection with the Austrian health care reform. There is a consensus between the federal ministries involved, provincial governments and social insurance funds that a formal agreement on sustainable implementation and finance for the programme needs to be arrived at by 2019.

Yes

Two external evaluations, one of the network establishment process (formative evaluation) and one of the benefits for the families assisted (summative evaluation) took place between 2015 and spring 2017. Both mostly used qualitative methods (interviews, focus groups, case studies and photovoice) in addition to analysis of data from ongoing documentation and an online survey. In addition, the National Centre continuously receives feedback forms from clients and collects feedback on training activities, conferences, etc. A pilot project to develop and test methods for studying the long-term effects of the programme was recently initiated. Another external evaluation will be commissioned In March 2018, this time focusing on quality standards.

The formative evaluation reveals the rapid progress of network roll-out within a short period. According to all the protagonists, the work of the National Centre is key to nationwide coordination, quality assurance, sustained political commitment and sustainability. The summative evaluation demonstrates the clear benefits of the programme for the families assisted. According to the findings, the early childhood intervention networks reinforce clients' psychological resources (i.e. social inclusion, self-esteem, positive family climate, parental skills and health literacy) and reduce the burdens on them (i.e. stress, anxiety, economic hardship, mental strain and social marginalisation). Thanks mostly to these improvements in the family situation, the programme has a positive impact on the child-parent bonding, interaction and relationships, as well as child development.

The outcome evaluation, based on the Swiss Outcome Model of Health Promotion, permitted the identification of a wide range of indicators of health determinants. These include: anxiety and stress; empowerment and self-esteem; health literacy and health outcomes; parental skills, child-parent-interaction and bonding; child development; and family climate.

The implementation of early childhood interventions and the National Centre is aligned with various policy plans at national level – most importantly the Austrian Child and Adolescents Health Strategy, the Austrian Health Targets and the Austrian Health Promotion Strategy. It is also included in the Austrian Governmental Programme, the Austrian Action Plan for Protection of Women from Violence, and the Child Health Strategy of the Social Security Funds. Thus, the partners are manifold – several federal ministries (Health, Family, Social Affairs, Women, Integration, Finance), representatives of the Austrian provincial governments (from a variety of fields, including health, child and youth welfare, social affairs and integration) and the Austrian Social Security Funds. In addition, in all phases - from the needs assessment and definition of the model through to nationwide implementation - representatives of service providers, professional groups, academia and civil society have been involved. The roles and contributions differ. Some partners are represented on the programme committees and thus contribute by providing advice and experience, and official backing, and promoting the programme in their respective spheres of action. Others belong to the regional networks and thus aid regional implementation.

The positive impact of the early childhood intervention programme has been enhanced by the fact that it was established by a structured process in line with the policy action cycle (problem analysis, definition of objectives, evidence based intervention planning, (pilot) implementation with evaluation, etc.). The experts at the National Centre played a key role at each stage. There is a high degree of involvement, participation and consultation of a variety of stakeholders from policy/administration, science and practice, as well as a permanent link between research and practice. This was a major facilitating factor with regard to acceptance of the plans as well as willingness to contribute to implementation. There was also a positive interaction with and link to relevant political processes – esp. the Austrian Health Targets – that likewise focus on intersectoral co-operation, and promotion of health equity and social justice. The proactive approach to contacting poor and vulnerable families proved successful. In a next step, there are plans to develop more specific quality criteria, so as to ensure that there are comparable and high quality standards across all the networks and to expand the impact research effort.