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To compare the characteristics of parents and children recruited for two randomised-controlled trials (RCTs) of parenting support in disadvantaged communities in Wales in order to explore the effects of community-based vs individual-based targeting in early prevention.

Parents from high-risk disadvantaged communities in Wales, where additional early intervention services were targeted as part of a Welsh Government early intervention strategy, were recruited to two RCTs of parenting interventions. In the first study parents of targeted three- and four-year-old children, who were screened, and deemed at risk of long-term problems, were recruited from Sure Start (SS) areas in Wales. In the second study parents of one- and two-year-old children living in disadvantaged Flying Start (FS) areas were recruited, with residence within the FS area being the only recruitment criterion.

FS areas are more strategically targeted as communities with a greater percentage of families with high levels of socio-economic disadvantage and associated risk than SS areas. Families in the toddler parenting trial based in FS areas, recruited without any additional screening, were experiencing higher levels of socio-economic deprivation, mental health problems and parenting stress as well as other known risks to child outcomes than the general population. However, when compared with the individually targeted population recruited for the SS study, they were shown to be experiencing significantly lower levels of these and other risks factors for poor child outcomes than the sample recruited for the SS trial where recruitment was based on known child risk factors. The paper discusses these findings and explores the implications of targeting by geographical area (community level targeting) alone vs targeting individual families by known risk factors. The findings suggest that screening measures would identify children at greatest risk of poor outcomes and whose families might benefit from additional targeted services. Suggestions for possible screening measures are also made.

This paper contributes to discussion about effective ways of allocating limited resources to best effect.

This paper aims to describe coal-face challenges to making services in the UK work to ensure the mental and physical health, safety and wellbeing of children.

After briefly referring to some challenges to effective joined-up service provision, it describes examples from the first author's experience of problems, during 30+ years as an NHS clinical child psychologist, and some solutions. It then describes two challenges that underpin many of these problems: lack of understanding of, or training in, evaluating evidence for interventions and a more general lack of knowledge about effective behaviour change principles.

The paper concludes with recommendations about how to achieve effective joined-up services. Common themes emerging from the research are discussed, including choosing evidence-based programmes, providing adequate training to staff, and increasing people's understanding of behavioural principles.

Having effective joined-up services would mean better services for parents and their children, and would be more cost-effective for the NHS. The ideas presented in this paper could also be applied to other services within the NHS.